Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 24636 | AZ |
NPI | 1174508667 |
---|---|
Provider Name | Dr. Richard J Claridge |
First Address | Phoenix, AZ 85054 |
Second Address | Phoenix, AZ 85054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200026119 | RAILROAD MEDICARE (01) | AZ |
364224 | (05) | AZ |
86080015085259A352 | TRIWEST (01) | AZ |
G37325 | (02) |