Individual
DEREK BLAINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
17385 LANKFORD HWY, PARKSLEY, VA 23421-3882
(757) 665-5996
(757) 665-5973
Mailing address
856 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601-1318
(757) 316-5800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102208196
VA
Other
Enumeration date
04/06/2021
Last updated
11/04/2024
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