Individual
DONALD WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 VASSAR NE, ALBUQUERQUE INDIAN HEALTH CENTER, ALBUQUERQUE, NM 87106
(505) 248-4065
(505) 248-4093
Mailing address
801 VASSAR NE, ALBUQUERQUE INDIAN HEALTH CLINIC, ALBUQUERQUE, NM 87106
(505) 248-4065
(505) 248-4093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
96216
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05679079
—
NM
01
—
13026
PRESBYTERIAN HEALTH PLAN
—
01
—
2618
LOVELACE SALUD
—
05
—
723553
—
AZ
01
—
8HZ91W
MEDICARE PTAN
NM
01
—
HSZ162
MEDICARE GROUP PTAN
NM
01
—
HSZ196
MEDICARE PART B
NM
05
—
K3526
—
NM
05
—
S5748
—
NM
Enumeration date
12/06/2006
Last updated
12/09/2010
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