Clark, Richard Wayne
Clark, Richard Wayne is an individual health care provider with primary practice located at 1245 Wilshire Blvd , Los Angeles CA 90017-4810. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Clark, Richard Wayne can be contacted via phone (213) 977-1215.Contact Information
Primary practice address
1245 Wilshire Blvd
Los Angeles CA 90017-4810
Phone: (213) 977-1215
Fax: (213) 977-0404
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | G23111 | California |
Profile Details
| NPI number | 1073554242 |
|---|---|
| LBN Legal business name | Clark, Richard Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2006 |
| Last updated | Jul 6th, 2011 - about 13 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 | 1073554242 | NPPES |
| California | MEDICAID | GR0071560 |
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