Provider Demographics
NPI:1043357916
Name:CLINE, RICHARD WILLIAM JR (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM
Last Name:CLINE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE G-50
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-4111
Mailing Address - Fax:866-521-2903
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE G-50
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-4111
Practice Address - Fax:866-521-2903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050050207Q00000X
TN2292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine