Individual
RICHARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD30288
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005719933
—
VA
05
—
026516400
—
DC
05
—
914510900
—
MD
Enumeration date
11/07/2006
Last updated
08/03/2007
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