| NPI | 1245412352 |
|---|---|
| Doing Business As | H. CLARK DERISO M.D.P.C. |
| Entity Type | Organization |
| Authorized Contact | HENRY CLARK DERISO Md 972-692-0755 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 013026) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-12-06 |