Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A71907 | CA |
N | 207PE0004X | Emergency Medical Services | A71901 | CA |
NPI | 1043293004 |
---|---|
Provider Name | Matthew Richard |
First Address | Lancaster, CA 93534-2894 |
Second Address | Lancaster, CA 93534-2894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 07/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A719010 | (05) | CA |
H77974 | (02) |