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NPI Code Detail

MEDICARE: DR. RICHARD GARY CLARK MD

MEDICARE: DR. RICHARD GARY 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 Physician11080TN
2208M00000XHospitalist Physician11080TN
3207R00000XInternal Medicine Physician11080TN

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 : 1962406793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD GARY CLARK MD
Provider Business Mailing Address
First Line : PO BOX 2861
Second Line :
City : CROSSVILLE
State : TN
Zip : 38557-2861
Country : US
Telephone Number : 931-879-5864
Fax Number : 931-879-3903
Provider Business Practice Location Address
First Line : 100 S DUNCAN ST
Second Line :
City : JAMESTOWN
State : TN
Zip : 38556-3009
Country : US
Telephone Number : 931-879-5864
Fax Number : 931-879-3903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 03/25/2024

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