Clark, James T.

Clark, James T. is an sole proprietor health care provider with primary practice located at 1100 E Lake St Suite 330, Tyler TX 75701-3343. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Clark, James T. can be contacted via phone (903) 595-5522.

Contact Information

Primary practice address
1100 E Lake St Suite 330 Tyler TX 75701-3343
Phone: (903) 595-5522
Fax: (903) 595-3834
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X D3181 Texas

Profile Details

NPI number 1073665964
LBN Legal business name Clark, James T.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 18th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073665964 NPPES
Texas Other 751477994 TAX ID #
Texas MEDICAID 11235461 TAX ID #
Texas Other 041539337 TAX ID #

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