Healthcare Provider Details

I. General information

NPI: 1245237080
Provider Name (Legal Business Name): RICHARD CLARK CLINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E RIO SALADO PKWY STE 300
TEMPE AZ
85281-9130
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 204
BRENTWOOD TN
37027-5064
US

V. Phone/Fax

Practice location:
  • Phone: 855-212-2273
  • Fax:
Mailing address:
  • Phone: 855-212-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number68449
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number173525-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: