Individual
DR. DESRA KAY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7227 N US HIGHWAY 1, COCOA, FL 32927-5020
(321) 877-2740
(321) 877-2793
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
OS12364
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019789000
—
FL
Enumeration date
06/22/2012
Last updated
07/21/2022
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