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MR. DEREK CLARK BOCO C.PED NPI 1497161590


NPI Information

NPI: 1497161590
Provider Name: MR. DEREK CLARK, BOCO C.PED
Classification: Orthotist - 222Z00000X
Entity Type: Individual
Address:
5111 JUAN TABO BLVD NE
STE A
ALBUQUERQUE, NM
ZIP 87111
Phone: (505) 200-9004
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MR. Derek Clark, BOCO C.PED is an orthotist in Albuquerque, NM. The provider is a health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. MR. Derek Clark, BOCO C.PED NPI is 1497161590. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5111 JUAN TABO BLVD NE
STE A
ALBUQUERQUE, NM
ZIP 87111
Phone: (505) 200-9004
Fax: (505) 271-0217

The enumeration date for this NPI number is 7/9/2014 and was last updated on 7/9/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1222Z00000XOrthotistC49914MARYLANDYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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