Individual
DESRAJ CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18511 HIGHLANDER MEDICS ST, FORT BLISS, TX 79906-5327
(915) 742-0353
Mailing address
18511 HIGHLANDER MEDICS ST, FORT BLISS, TX 79906-5327
(915) 742-0353
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
30773
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2016
Last updated
10/30/2023
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