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:
Health care specialties
| Specialty | Code | License # | 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 last year |
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 | 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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