Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Derek Clark, BOCOCPED

Individual provider Orthotist · NPI 1497161590

Mr. Derek Clark, BOCOCPED is an Orthotist in Albuquerque, New Mexico. Licensed in Maryland. Registered with an NPI since 2014.

Licensed in
MD
In the registry since
2014

Practice location Address checks out

5111 Juan Tabo Blvd NE Ste A
Albuquerque, NM 87111
Phone: (505) 200-9004
Fax: (505) 271-0217
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthotist (primary) Taxonomy 222Z00000X · Licence C49914 (MD)

Record details

NPI number1497161590
Entity typeIndividual (Type 1)
GenderMale
Credentials BOCOCPED
Sole proprietorNo
NPI enumeratedJuly 9, 2014
Last updated in NPPESJuly 9, 2014
Mailing address5111 Juan Tabo Blvd Ne, Ste A, Albuquerque, NM 87111