| Doctor Name: | ROGER DALE CLARK |
| NPI Number: | 1992976542 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 80241 |
| Business Practice Address: | 4300 W Waco Dr A2 Waco, TX - 767107010 |
| Business Phone Number: | 2543990405 |
| Business Fax Number: | 2543990316 |
| Mailing Address: | 400 S Henderson St, FORT WORTH |
| State: | TX |
| Postal Code: | 761041017 |
| Phone Number: | 8173352583 |
| Fax Number: | 8175463672 |
| NPI Enumeration Date: | 03/21/2008 |
| NPI Last Update Date: | 03/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | 80241 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |