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General NPI Number Information
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NPI Number | 1346237070
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Entity Type | Individual
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Provider Name | DON R. CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 607 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5211
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Country | US
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Telephone | 505-623-3420
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Fax | 505-622-2820
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Provider Business Mailing Address
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Address Line | 313 W COUNTRY CLUB RD SUITE # 8
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 505-623-3420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 59-8
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License Number State | NM
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