Individual
DR. JILL ELISABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
715 DR MARTIN LUTHER KING JR AVE NE STE 301, ALBUQUERQUE, NM 87102-3668
(505) 727-7090
Mailing address
715 DR MARTIN LUTHER KING JR AVE NE STE 301, ALBUQUERQUE, NM 87102-3668
(505) 727-7090
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
61161110
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295922052
—
UT
01
—
MD2024-1149
STATE LICENSE
NM
Enumeration date
09/26/2007
Last updated
06/27/2025
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