Individual
DOUGLAS PAUL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2211 LOMAS BLVD NE, DEPATMENT OF PATHOLOGY, ALBUQUERQUE, NM 87106-2719
(505) 272-4814
(505) 272-8084
Mailing address
1 UNIVERSITY OF NEW MEXICO PATHOLOGY MSC08, ALBUQUERQUE, NM 87131-0001
(505) 272-4814
(505) 272-8084
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD2013-0937
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231351100
—
MD
Enumeration date
05/17/2006
Last updated
12/16/2013
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