Charles B. Clark III, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

D9396 Issued in TX

Practice address

6025 Metropolitan Dr
Suite 205
Beaumont, TX 77706-2408

Phone

(409) 899-4999

Fax

(409) 899-3978

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425513600000",
    "number": "1770689358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 METROPOLITAN DR",
            "address_2": "SUITE 205",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777062408",
            "telephone_number": "409-899-4999",
            "fax_number": "409-899-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 METROPOLITAN DR",
            "address_2": "SUITE 205",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777062408",
            "telephone_number": "409-899-4999",
            "fax_number": "409-899-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2015-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "D9396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0981946-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "359865",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cima Hospice of Houston, LLC
• Ronald Citrano, DDS
• City of Beaumont
• City of Beaumont Public Health Department
• CJ Homecare Inc.
• Jerry Doyle Clark, M.D.
• Joseph Clark, DC
• Linda Gaye Clark
• Burnet Todd Clarke, MD
• Lisa Contreras Clarke, RD, CSSD

• Neurological Surgery Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Neurological Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.