Individual
ROGER DALE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HIS
Contact information
Practice address
4555 E UNIVERSITY BLVD STE C7, ODESSA, TX 79762-8137
(432) 444-5200
Mailing address
4555 E UNIVERSITY BLVD STE C7, ODESSA, TX 79762-8137
(432) 444-5200
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
80241
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07386906
DRIVERS LICENSE
TX
Enumeration date
03/21/2008
Last updated
01/14/2022
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