Provider Demographics
NPI:1649222365
Name:REMARK, RICHARD RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAY
Last Name:REMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 EMERALD HILL WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5740
Mailing Address - Country:US
Mailing Address - Phone:702-480-8877
Mailing Address - Fax:702-363-8636
Practice Address - Street 1:9020 EMERALD HILL WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5740
Practice Address - Country:US
Practice Address - Phone:702-252-7245
Practice Address - Fax:702-363-8636
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200290104Medicaid
COCO307090Medicare PIN
C96498Medicare UPIN
NV200290104Medicaid