Individual
DR. JUSTIN WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 22ND ST, LUBBOCK DERMATOLOGY, LUBBOCK, TX 79410-1309
(806) 796-7193
(806) 796-0034
Mailing address
3601 22ND ST, LUBBOCK, TX 79410-1309
(806) 796-7193
(806) 796-0034
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
K4662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120680701
—
TX
Enumeration date
09/13/2005
Last updated
10/25/2007
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