Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E2669 | CA |
NPI | 1013956838 |
---|---|
Provider Name | Douglas H. Richie JR. |
First Address | Seal Beach, CA 90740-5999 |
Second Address | Seal Beach, CA 90740-5999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 12/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11433 | (02) | CA |