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Individual
DEANDRA L CLARK
Active
Individual
DEANDRA L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME76610
FL
208000000X
Pediatrics Physician
Primary
TL32184
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258609600
—
FL
Enumeration date
02/15/2006
Last updated
04/27/2010
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