Clark, Randil L
Clark, Randil L is an individual health care provider with primary practice located at 980 Ironwood Dr W Ste 104, Coeur D' Alene ID 83814. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Clark, Randil L can be contacted via phone (208) 667-0621.Contact Information
Primary practice address
980 Ironwood Dr W Ste 104
Coeur D' Alene ID 83814
Phone: (208) 667-0621
Fax: (208) 664-1709
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | M-5699 | Idaho |
Profile Details
| NPI number | 1205961182 |
|---|---|
| LBN Legal business name | Clark, Randil L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2007 |
| Last updated | May 25th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205961182 | NPPES |
| Idaho | MEDICAID | 002667200 |
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