Individual
MATTHEW RYAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15830 BALLANTYNE MEDICAL PL STE 225, CHARLOTTE, NC 28277-0760
(704) 919-1105
(704) 910-3163
Mailing address
1390 S POTOMAC ST STE 124, AURORA, CO 80012-4529
(303) 368-8611
(303) 368-9791
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2023-00924
NC
207N00000X
Dermatology Physician
MMD89666MD
SC
207ND0101X
MOHS-Micrographic Surgery Physician
2023-00924
NC
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD195653
OR
207ND0101X
MOHS-Micrographic Surgery Physician
MMD89666MD
SC
Other
Enumeration date
05/30/2013
Last updated
08/29/2023
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