Clark, Richard Travis

Clark, Richard Travis is an individual health care provider with primary practice located at 2211 Lomas Blvd Ne , Albuquerque NM 87106-2719. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Clark, Richard Travis can be contacted via phone (505) 272-1476.

Contact Information

Primary practice address
2211 Lomas Blvd Ne Albuquerque NM 87106-2719
Phone: (505) 272-1476
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD60212011 Washington
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD2018-0142 New Mexico

Profile Details

NPI number 1568432557
LBN Legal business name Clark, Richard Travis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated Oct 20th, 2023 - about 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568432557 NPPES
Washington Other 0365600 L&I EVERGREEN RADIA
Washington Other 0293210 L&I EVERGREEN RADIA
Washington MEDICAID 1568432557 L&I EVERGREEN RADIA
Washington Other 0365598 L&I EVERGREEN RADIA
Washington Other 0365595 L&I EVERGREEN RADIA
Washington MEDICAID 2017034 L&I EVERGREEN RADIA
Washington Other 0365599 L&I EVERGREEN RADIA
Washington Other 158600 L&I EVERGREEN RADIA

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