DR. RODERICK V. CLARK (NPI# 1225066939) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225066939 |
| Entity Type | Individual |
| Full Name | DR. RODERICK V. CLARK |
| Credential | M.D. |
| Practice Address |
2804 Ambassador Caffery Pkwy Lafayette LA 70506-5906 |
| Practice Telephone | 3379815156 |
| Practice Fax Number | 3379810673 |
| Mailing Telephone | 3379815156 |
| Mailing Fax Number | 3379810673 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-09-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
019518 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1379875 | 05 |
| Street Address |
2804 AMBASSADOR CAFFERY PKWY |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70506-5906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821034778 | Alfonso Lebron-berges | Internal Medicine | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2006-06-21 |
| 1912468083 | Kristen Williams Lasseigne | Nurse Practitioner | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2019-03-29 |
| 1285049759 | Christine Boutte | Nurse Practitioner | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2014-06-24 |
| 1982808887 | Stephanie L White | Specialist/Technologist, Other | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70505 | 2007-06-13 |
| 1558473322 | Bio-medical Applications of Louisiana, LLC | Clinic/Center | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417421447 | Maranda Washington | Student in an Organized Health Care Education/Training Program | 202 Reinhardt Drive, Lafayette, LA 70506 | 2019-01-12 |
| 1447742473 | Glenda Gravouilla Poulan | Driver | 330 Guilbeau Rd, Lafayette, LA 70506 | 2018-06-05 |
| 1194215905 | Angelica Plumbar | Case Manager/Care Coordinator | 1304 Bertrand Dr Ste B21304, Lafayette, LA 70506 | 2018-05-16 |
| 1801394820 | Acadiana Ambulatory Health Care Services | Non-Pharmacy Dispensing Site | 207 Westmark Blvd., Lafayette, LA 70506 | 2018-01-24 |
| 1578070041 | Kimberly Lois Robinson | Counselor | 203 Pinto St, Lafayette, LA 70506 | 2018-01-05 |
| 1558890814 | Shanece Marie Solomon | Speech-Language Pathologist | 326 Guilbeau Rd Apt 240, Lafayette, LA 70506 | 2017-06-08 |
| 1225565625 | Keena Lewis | Case Manager/Care Coordinator | 121 Kohen Luke Dr, Lafayette, LA 70506 | 2017-05-16 |
| 1326571498 | Natasha Deville | Community/Behavioral Health | 1408 W Willow St 162, Lafayette, LA 70506 | 2017-04-06 |
| 1952846826 | Mia D Arthur | Behavioral Analyst | 511 Monarch Dr, Lafayette, LA 70506 | 2016-12-30 |
| 1265983340 | Eric Prince | Specialist/Technologist | 202 Reinhardt Dr., Lafayette, LA 70506 | 2016-10-24 |
| Find all providers in zip 70506 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754852 | Western Nephrology & Metabolic Bone Disease, P.C. | Internal Medicine | 2655 Crescent Dr Ste D, Lafayette, CO 80026-3373 | 2020-09-11 |
| 1104014349 | Louisiana Kidney Update, LLC | Internal Medicine | 4811 Ambassador Caffery Pkwy Fl 4, Lafayette, LA 70508-7265 | 2007-10-12 |
| 1821216144 | Ladebe LLC | Internal Medicine | 804 Richland Ave, Lafayette, LA 70508-6661 | 2007-04-23 |
| 1821034778 | Alfonso Lebron-berges | Internal Medicine | 2804 Ambassador Caffery Pkwy, Lafayette, LA 70506-5906 | 2006-06-21 |
| 1992747349 | Acadiana Renal Physicians Amc | Internal Medicine | 300 W Saint Mary Blvd, Lafayette, LA 70506-4638 | 2006-06-11 |
| 1447228184 | Akram Al-makki | Internal Medicine | 915 Mezzanine Dr, Suite A, Lafayette, IN 47905-8637 | 2006-03-09 |
| 1093706582 | Steven W Kraft | Internal Medicine | 2655 Crescent Dr, Suite C, Lafayette, CO 80026-3372 | 2005-11-02 |
| 1386635878 | Richard K Halterman | Internal Medicine | 2655 Cresenct Drive, Suite C, Lafayette, CO 80026-3376 | 2005-11-02 |
| 1275524761 | Karen M Lochhead | Internal Medicine | 300 Exempla Cir Ste 360, Lafayette, CO 80026-3395 | 2005-11-02 |
| 1275194193 | Total Health Clinic LLC | Internal Medicine | 610 Guilbeau Rd, Lafayette, LA 70506-8707 | 2019-06-21 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.