Clark, Justin Wayne
Clark, Justin Wayne is an individual health care provider with primary practice located at 3601 22Nd St Lubbock Dermatology, Lubbock TX 79410-1309. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Clark, Justin Wayne can be contacted via phone (806) 796-7193.Contact Information
Primary practice address
3601 22Nd St Lubbock Dermatology
Lubbock TX 79410-1309
Phone: (806) 796-7193
Fax: (806) 796-0034
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | K4662 | Texas |
Profile Details
| NPI number | 1639164098 |
|---|---|
| LBN Legal business name | Clark, Justin Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2005 |
| Last updated | Oct 25th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639164098 | NPPES |
| Texas | MEDICAID | 120680701 |
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