NPI 1497161590

Derek Clark, BOCOCPED

Practitioner Orthotist Albuquerque, NM

Practice location

Address: 5111 Juan Tabo Blvd NE STE a, Albuquerque, NM 87111
Phone: (505) 200-9004
Fax: (505) 271-0217

Registered specialties

Orthotist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X Licence C49914 (MD)

Other Orthotist providers in New Mexico →

Registry record

NPI: 1497161590
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Jul 2014
Record last updated: 9 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.