Provider Demographics
NPI:1245237080
Name:CLINE, RICHARD CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CLARK
Last Name:CLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 71506
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0506
Mailing Address - Country:US
Mailing Address - Phone:801-903-8956
Mailing Address - Fax:801-288-8987
Practice Address - Street 1:154 MYRTLE AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4850
Practice Address - Country:US
Practice Address - Phone:801-288-9002
Practice Address - Fax:801-288-8987
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT173525-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011008Medicare ID - Type Unspecified
UTD87719Medicare UPIN