DOUGLAS A. CLARK (NPI# 1114920238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114920238 |
| Entity Type | Individual |
| Full Name | DOUGLAS A. CLARK |
| Credential | MD |
| Practice Address |
4901 Lang Ave Ne Albuquerque NM 87109-4397 |
| Practice Telephone | 5058428171 |
| Practice Fax Number | 5052460684 |
| Mailing Telephone | 5058428171 |
| Mailing Fax Number | 5052460684 |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2017-01-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
86-199 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | T5533 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487008603 | Douglas Robert Clark | Optometrist | 446 N State Road 198, Salem, UT 84653 | 2016-04-14 |
| 1760735328 | Douglas Lee Clark | Pharmacist | 9750 Highway 70, Minocqua, WI 54548-9753 | 2012-10-19 |
| 1821308974 | Douglas Owen Clark | Obstetrics & Gynecology | 21010 Black Walnut Ln, A, Brookfield, WI 53045-4062 | 2010-10-07 |
| 1427135185 | Douglas James Clark | Social Worker | Brockton Va Medical Center, 940 Belmont St., Brockton, MA 02301 | 2006-11-01 |
| 1487682498 | Douglas Marley Clark | Physician Assistant | 2317 S Roane St, Community Care Walk In Clinic, Harriman, TN 37748-8653 | 2006-06-29 |
| 1326038035 | Douglas A. Clark | Physician Assistant | 9601 Baptist Health Dr Ste 860, Little Rock, AR 72205-6375 | 2005-10-25 |
| 1780688572 | Douglas George Clark | Internal Medicine | 12665 Garden Grove Blvd, Suite 301, Garden Grove, CA 92843-1901 | 2005-06-09 |
| 1528211786 | Douglas Craig Clark | Dentist | 118 W 5th St, Covington, KY 41011-1481 | 2008-10-30 |
| 1568592186 | Douglas E Clark | Pharmacist | 129 Gill St, Alcoa, TN 37701-2656 | 2007-03-06 |
| 1396892907 | Douglas A Clark | Orthopaedic Surgery | 2055 E Southern Ave, Suite G, Tempe, AZ 85282-7507 | 2007-01-04 |
| Street Address |
4901 LANG AVE NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109-4397 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194387555 | Courtney Marquez | Physician Assistant | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2019-07-05 |
| 1922570118 | Angerene Mitchell-matthews | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2018-12-28 |
| 1700362597 | Sandra Lee Rowe | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2018-07-14 |
| 1538612353 | Jennifer Vergeer | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2016-07-28 |
| 1528418274 | Rachel S Camp | Physician Assistant | 4901 Lang Ave Ne, Suite 100, Albuquerque, NM 87109-4495 | 2016-06-14 |
| 1457707150 | Deborah Schwartz | Family Medicine | 4901 Lang Ave Ne, Albuquerque, NM 87109 | 2016-05-11 |
| 1407227002 | Truecare LLC | Family Medicine | 4901 Lang Ave Ne, Ste 202, Albuquerque, NM 87109-4495 | 2015-10-08 |
| 1174911093 | New Mexico Center for Minimally Invasive Therapies | Radiology | 4901 Lang Ave Ne, Suite 202, Albuquerque, NM 87109-4495 | 2014-12-30 |
| 1538566211 | Felicia R. Mazzei | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109 | 2014-11-25 |
| 1942631403 | Steve Sambrano | Physician Assistant | 4901 Lang Ave Ne, Ste 100, Albuquerque, NM 87109-4495 | 2013-12-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033435490 | Heloisa Prado Soares | Internal Medicine | Msc07 4025 1 University of Nm, Albuquerque, NM 87131-9416 | 2010-04-10 |
| 1487743092 | Wadih Arap | Internal Medicine | 1 University of New Mexico Msc 07 4025, 1201 Camino De Salud, Albuquerque, NM 87131-0001 | 2006-10-12 |
| 1114990298 | Murray M Bern | Internal Medicine | Unm Cancer Ctr, Msc 07-4025 1201 Camino De Salud, Albuquerque, NM 87131-0001 | 2006-02-09 |
| 1073506531 | Kenneth J Smith | Internal Medicine | 8300 Constitution Ave. Ne, Presbyterian Oncology Kaseman Hospital, Albuquerque, NM 87110-7613 | 2005-08-30 |
| 1790183135 | Lovelace Health System, LLC | Internal Medicine | 715 Dr Martin Luther King Jr Ave Ne, Suite 102, Albuquerque, NM 87102-3661 | 2014-12-17 |
| 1235579632 | Gautam Kishore Valecha | Internal Medicine | 8300 Constitution Ave Ne, Albuquerque, NM 87110-7613 | 2013-06-28 |
| 1326393380 | Neda Hashemi Sadraei | Internal Medicine | 1 University of New Mexico, Albuquerque, NM 87131 | 2012-07-16 |
| 1184980989 | Paul Allen Brittain | Internal Medicine | 715 Dr Martin Luther King Jr Ave Ne Ste 102, Albuquerque, NM 87102 | 2012-04-05 |
| 1972824084 | Emrullah Yilmaz | Internal Medicine | 933 Bradbury Dr Se, Suite 2222, Albuquerque, NM 87106-4374 | 2010-06-14 |
| 1023342466 | Rubens Barros Costa Filho | Internal Medicine | 715 Dr Martin Luther King Jr Ave Ne, Suite 102, Albuquerque, NM 87102-3661 | 2009-10-01 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
Please comment or provide details below to improve the information on DOUGLAS A. CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.