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Individual

RICHARD WAYNE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1245 WILSHIRE BLVD, LOS ANGELES, CA 90017-4810
(213) 977-1215
(213) 977-0404
Mailing address
1245 WILSHIRE BLVD, LOS ANGELES, CA 90017-4806
(213) 977-1215
(213) 977-0404

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G23111
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0071560
CA
Enumeration date
06/09/2006
Last updated
07/06/2011
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