Provider Demographics
NPI:1558567503
Name:CLARK, RICHARD PATTERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PATTERSON
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:83 SCRIPPS DRIVE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-925-3912
Mailing Address - Fax:916-925-3103
Practice Address - Street 1:83 SCRIPPS DRIVE
Practice Address - Street 2:SUITE #130
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-925-3912
Practice Address - Fax:916-925-3103
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC41548208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37627Medicare UPIN