Individual
ELLIS RICHARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 BELLEVUE ST SE, SUITE 300, SALEM, OR 97301-3819
(503) 364-3704
Mailing address
PO BOX 4008, PORTLAND, OR 97208-4008
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD15586
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022509
—
OR
Enumeration date
06/26/2006
Last updated
07/08/2007
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