Individual
MR. TONY LEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
610 RED HILLS ROAD, HATCH, NM 87937
(575) 520-0292
Mailing address
4542 MONTGOMERY, ALBUQUERQUE, NM 87109
(575) 621-3940
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
75659
NM
Other
Enumeration date
04/25/2018
Last updated
01/11/2024
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