Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 47576 | MA |
NPI | 1013029651 |
---|---|
Provider Name | Dr. Clifford George Risk |
First Address | Marlborough, MA 01752-3980 |
Second Address | Marlborough, MA 01752-3980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 14/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6166164 | (05) | MA |
A66274 | (02) | MA |