Provider Demographics
NPI:1346237070
Name:CLARK, DON R (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:R
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:313 W COUNTRY CLUB RD
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5804
Mailing Address - Country:US
Mailing Address - Phone:505-623-3420
Mailing Address - Fax:
Practice Address - Street 1:607 W COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5211
Practice Address - Country:US
Practice Address - Phone:505-623-3420
Practice Address - Fax:505-622-2820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM59-8207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine