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NPI Code Detail

MEDICARE: RUSSELL PATRICK CLARK MD

MEDICARE: RUSSELL PATRICK CLARK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician10404NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790787497
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL PATRICK CLARK MD
Provider Business Mailing Address
First Line : 6900 N PECOS RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-4400
Country : US
Telephone Number : 702-791-9000
Fax Number :
Provider Business Practice Location Address
First Line : 6900 N PECOS RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-4400
Country : US
Telephone Number : 702-791-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 06/19/2024

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Directions to “ RUSSELL PATRICK CLARK MD” Practice Location

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