DR. JUSTIN WAYNE CLARK (NPI# 1639164098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639164098 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN WAYNE CLARK |
| Credential | MD |
| Practice Address |
3601 22nd St Lubbock Dermatology Lubbock TX 79410-1309 |
| Mailing Address |
3601 22nd St Lubbock TX 79410-1309 |
| Practice Telephone | 8067967193 |
| Practice Fax Number | 8067960034 |
| Mailing Telephone | 8067967193 |
| Mailing Fax Number | 8067960034 |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2007-10-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | K4662 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 120680701 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493226 | Justin Clark | Student in an Organized Health Care Education/Training Program | 7337 Wythe Dr, Noblesville, IN 46062-7785 | 2020-10-08 |
| 1942531868 | Justin Clark | Pharmacist | 12050 N Dove Mt Blvd, Marana, AZ 85658 | 2010-01-15 |
| 1750528964 | Justin Liam Clark | Physical Therapist | 102 Fairview Pk Dr, Elmsford, NY 10523-1518 | 2009-01-09 |
| 1598945644 | Justin Charles Clark | Neurological Surgery | 414 Plymouth Ne, Grand Rapids, MI 49505-6041 | 2007-11-06 |
| 1538129085 | Justin Clark | Allergy & Immunology | 362 Beal Pkwy Nw Ste 105, Fort Walton Beach, FL 32548-3926 | 2006-03-27 |
| 1619458999 | Justin Blake Clark | Social Worker | 9600 Veterans Dr., Mailstop: Mhc 61-116-c, Tacoma, WA 98493-5000 | 2018-08-24 |
| 1912483645 | Justin D Clark | Social Worker | 533 26th St Ste 100, Ogden, UT 84401-2459 | 2018-07-16 |
| 1235621327 | Justin M Clark | Family Medicine | 1801 Hickman Rd, Des Moines, IA 50314-1505 | 2018-06-04 |
| 1760987481 | Justin Clark | Occupational Therapist | 14151 15 Mile Rd, Sterling Heights, MI 48312-5507 | 2018-03-26 |
| 1285136846 | Justin Clark | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-28 |
| Street Address |
3601 22ND ST LUBBOCK DERMATOLOGY |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245707827 | Kristen Knight | Physician Assistant | 3601 22nd St, Lubbock, TX 79410-1309 | 2018-10-31 |
| 1780742536 | Cynthia Lynn Adams | Nurse Practitioner | 3601 22nd St, Lubbock, TX 79410-1309 | 2006-12-05 |
| 1295721066 | Lubbock Dermatology and Skin Cancer Center | Dermatology | 3601 22nd St, Lubbock, TX 79410-1309 | 2005-09-27 |
| 1457346819 | Richard H Hope | Dermatology | 3601 22nd St, Lubbock, TX 79410-1309 | 2005-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962928440 | Long & Harris Dermatology Pllc | Dermatology | 6102 82nd St Ste 15, Lubbock, TX 79424-0802 | 2017-08-16 |
| 1649711904 | William David Boothe Jr. | Dermatology | 3601 4th St Stop 6211, Lubbock, TX 79430 | 2017-03-19 |
| 1033572136 | Uyen Ngoc Mui | Dermatology | 3601 4th St Stop 9400, Lubbock, TX 79430-9400 | 2016-04-05 |
| 1548363971 | Robert Franklin Bloom | Dermatology | 3413 20th St, Lubbock, TX 79410 | 2006-09-07 |
| 1285642603 | Michael Hood Chamales | Dermatology | 15010 Slide Dr, Lubbock, TX 79424 | 2006-08-03 |
| 1427087345 | Lehman Dermatology Clinic, P.a. | Dermatology | 3715 21st St, Lubbock, TX 79410-1219 | 2006-07-02 |
| 1093701468 | Brent R. Paulger | Dermatology | 2202 Ithaca Ave, Lubbock, TX 79410-1332 | 2005-09-21 |
| 1922463959 | Skin Cancer Institute Pllc | Dermatology | 4709 66th St, Lubbock, TX 79414-4877 | 2015-12-17 |
| 1629488143 | Randy Atkins | Dermatology | 3601 4th St, Ms 9410, Lubbock, TX 79430-0002 | 2014-05-06 |
| 1851658355 | Heather Layher | Dermatology | 3601 4th St, Lubbock, TX 79430-0002 | 2012-04-20 |
| Find all providers in LUBBOCK | ||||
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| 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.