DR. PAUL CLARK (NPI# 1225052467) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225052467 |
| Entity Type | Individual |
| Full Name | DR. PAUL CLARK |
| Credential | D.O. |
| Practice Address |
3551 Roger Brooke Dr Fort Sam Houston TX 78234-4504 |
| Mailing Address |
3551 Roger Brooke Dr San Antonio TX 78234-4504 |
| Practice Telephone | 2105390784 |
| Mailing Telephone | 5714090055 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-10-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
0102202652 | VA | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
0102202652 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1225052467 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 782365638 | 5714090055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235540931 | Paul A Clark | Physical Therapist | 410 Avenue G, Levelland, TX 79336-3719 | 2014-05-15 |
| 1154338945 | Paul K Clark | Chiropractor | 725 E Commercial Ave, Lowell, IN 46356-2303 | 2006-08-02 |
| 1396769154 | Paul Anthony Clark | Dentist | 759 E 200th St, Euclid, OH 44119-2504 | 2006-07-26 |
| 1124594742 | Paul Edward Clark | Social Worker | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2018-10-22 |
| 1619362597 | Paul Ray Clark | Student in an Organized Health Care Education/Training Program | 6431 Fannin St, Msb 4.331, Houston, TX 77030-1501 | 2015-03-30 |
| 1174939102 | Paul Clark | Physical Therapist | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2014-07-10 |
| 1619388659 | Paul Richard Clark | Student in an Organized Health Care Education/Training Program | 2500 N State St, Department of Neurosurgery, Jackson, MS 39216-4500 | 2014-05-13 |
| 1083051684 | Paul E Clark | Social Worker | 47 Town St, Norwich, CT 06360-2315 | 2013-05-23 |
| 1306289699 | Paul Allen Clark | Occupational Therapist | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2013-04-17 |
| 1174893945 | Paul G Clark | Social Worker | 4400 University Dr, Fairfax, VA 22030-4422 | 2012-01-10 |
| Street Address |
3551 ROGER BROOKE DR |
| City | FORT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093338 | Aneesh N/a Benoy | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-11-02 |
| 1164021580 | William Edward Vick | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-19 |
| 1548868003 | Julia D Coffey | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-15 |
| 1801493465 | Emiri Elliott | Registered Nurse | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-07 |
| 1437756574 | Clarence Michael Sullivan | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-01 |
| 1093320350 | Natalie Marie Greene | Physical Therapist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-09-14 |
| 1033722509 | Kody Vallejo | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-25 |
| 1558972620 | Renee Therese Hart | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-12 |
| 1235749722 | Emily Ann Robinson | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-09 |
| 1902415367 | Hannah Daniel | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255942884 | Thomas Ballas | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa-fort Sam Houston, Department of Behavioral Medicine-mche-dbm, San Antonio, TX 78234 | 2020-08-17 |
| 1124657366 | Wendy Harris | Pharmacist | 3041 Garden Ave, Fort Sam Houston, TX 78234 | 2020-04-08 |
| 1215564729 | Travis Frantz | Student in an Organized Health Care Education/Training Program | 3551 Rodger Brooke Drive, Jbsa Fort Sam Houston, TX 78234 | 2020-03-25 |
| 1508492695 | Matthew Grossmann | Student in an Organized Health Care Education/Training Program | San Antonio Military Medical Center, Mche-zdm-m, Internal Medicine Residency, 3551 Roger Brooke Dr., Jbsa-fort Sam Houston, TX 78234 | 2020-03-20 |
| 1235793407 | Jessica Maria May Franklin | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa Fort Sam Houston, San Antonio, TX 78234 | 2019-04-23 |
| 1730663477 | Glen Snyder | Military Health Care Provider | 3488 Garden Ave Anderson Hall, Fort Sam Houston, San Antonio, TX 78234 | 2018-09-19 |
| 1265919336 | Ashley Elizabeth Malawey | Military Health Care Provider | 3222 Cpl Johnson Road, San Antonio, TX 78234 | 2018-07-23 |
| 1053805515 | Rene Espinosa | Social Worker | San Antonio Medical Center, 3551 Roger Brooke Dr, Jbsa, TX 78234 | 2018-06-19 |
| 1235622333 | Melanie Edith Rivera | Military Health Care Provider | 3600 Roger Brooke Drive, San Antonio, TX 78234 | 2018-06-13 |
| 1063909158 | Benjamin Walker Appelo | General Practice | San Antonio Mil Med Center 3551 Roger Brooke Dr, Mche-zdm-m, San Antonio, TX 78234 | 2018-04-16 |
| Find all providers in zip 78234 | ||||
| Taxonomy Code | 2085P0229X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Pediatric Radiology |
| A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770985103 | Ach Medical Imaging, LLC | Radiology | 9889 Bellaire Blvd Ste E202, Houston, TX 77036-3463 | 2014-09-17 |
| 1053633727 | Thomas Stanley Lipscomb | Radiology | 4251 Sarita Ct, Fort Worth, TX 76109-4732 | 2010-02-23 |
| 1982889887 | Steven A Ross | Radiology | 4815 Alameda Avenue, El Paso, TX 79905-2705 | 2008-01-09 |
| 1336261403 | Rajvee M Shah | Radiology | 7168 Manor Oaks Dr, Dallas, TX 75248-2241 | 2007-04-06 |
| 1942377148 | Carmen Rene Emery | Radiology | 333 N. San Saba, River City Imaging Associates, San Antonio, TX 78207 | 2006-11-30 |
| 1174569842 | Mario E Ruiz | Radiology | 18126 Prestonshire, San Antonio, TX 78258-4473 | 2006-06-21 |
| 1053386326 | Linda Patricia Thomas | Radiology | 23814 Riata Cyn, San Antonio, TX 78258-4897 | 2006-02-21 |
| 1609499680 | Janina Patsch | Radiology | 6701 Fannin St Ste 470, Houston, TX 77030-2608 | 2020-05-25 |
| 1174037287 | Gilead Image Center | Radiology | 3910 N Jackson Rd, Pheer, TX 78577 | 2017-11-28 |
| 1700204427 | Atul Anant Utturkar | Radiology | 5323 Harry Hines Blvd, Dallas, TX 75390-7201 | 2014-03-31 |
| Find all providers with the same taxonomy | ||||
| City | FORT SAM HOUSTON |
| Zip Code | 78234 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.