Individual
MR. DEREK CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BOCO C.PED
Contact information
Practice address
5111 JUAN TABO BLVD NE, STE A, ALBUQUERQUE, NM 87111
(505) 200-9004
(505) 271-0217
Mailing address
5111 JUAN TABO BLVD NE, STE A, ALBUQUERQUE, NM 87111
(505) 200-9004
(505) 271-0217
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
C49914
MD
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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