Individual
DR. RICHARD TRAVIS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-1476
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD2018-0142
NM
2085R0202X
Diagnostic Radiology Physician
MD60212011
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0293210
L&I
WA
01
—
0365595
L&I RADIA-REST OF WA
WA
01
—
0365598
L&I RADIA-KING COUNTY
WA
01
—
0365599
L&I SWEDISH RADIA EDMONDS
WA
01
—
0365600
L&I EVERGREEN RADIA
WA
05
—
1568432557
—
WA
01
—
158600
PTAN
WA
05
—
2017034
—
WA
Enumeration date
01/24/2006
Last updated
01/30/2025
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