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Contact Information

CLINTON S PARK, MD
500 S HENDERSON ST STE 200
FORT WORTH, TX76104-2154
 Phone: 817-413-1500
 Fax: 817-413-1499
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
 

Radiation Oncology

2085R0203X
Indicates primary specialty

NPI Profile & details for CLINTON S PARK · (Male)

NPI # 1295932242
Status Active
Credentials MD
Entity Individual
Enumeration date 07/02/2007
Last updated 12/09/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • TX License # BP10022820
  • TX License # N3228
  • TX Medicaid 202476201
  • TX Medicaid 202476202
  • TX Other 8CA240 BLUECROSS BLUESHIELD OF TEXAS
  • TX Other P00764078 RAILROAD MEDICARE
Hospital affiliation(s)
  • TEXAS HEALTH HARRIS METHODIST FORT WORTH - (Acute Care)
    1301 PENNSYLVANIA AVENUE
    FORT WORTH, TX 76104
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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