Individual
DUMONT F. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1925 E ORMAN AVE, SUITE 254, PUEBLO, CO 81004-3537
(719) 564-1542
(719) 566-0916
Mailing address
452 S HAHNS PEAK AVE, PUEBLO WEST, CO 81007-6031
(719) 547-7662
(719) 566-0916
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
19963
CO
207RS0012X
Sleep Medicine (Internal Medicine) Physician
19963
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01199637
—
CO
Enumeration date
08/31/2005
Last updated
10/18/2010
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