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General NPI Number Information
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NPI Number | 1639156284
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Entity Type | Individual
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Provider Name | RITCHIE L CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 811 E PARRISH AVE
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City | OWENSBORO
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State | KY
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Zip | 42303-3258
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Country | US
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Telephone | 270-688-2936
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22171
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City | OWENSBORO
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State | KY
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Zip | 42304-2171
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Country | US
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Telephone | 812-471-1591
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Fax | 812-471-6650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 21610
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License Number State | KY
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