Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301029346 | MI |
NPI | 1275861734 |
---|---|
Provider Name | Phillip Oliver Richards |
First Address | Indian Wells, CA 92210-6150 |
Second Address | Indian Wells, CA 92210-6150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2009 |
Last Update Date | 21/11/2009 |