Doctor Name: | AUSTRALIA D CLARK |
NPI Number: | 1528329562 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 6318 Fm 1488 Rd Ste 100 Magnolia, TX - 773542763 |
Business Phone Number: | 9363213110 |
Business Fax Number: | 9363213125 |
Mailing Address: | 6318 Fm 1488 Rd Ste 100, MAGNOLIA |
State: | TX |
Postal Code: | 773542763 |
Phone Number: | 9363213110 |
Fax Number: | 9363213125 |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 06/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |