Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD2015-0273 | NM |
NPI | 1033143797 |
---|---|
Provider Name | Robert J Richards |
First Address | Las Cruces, NM 88011-8259 |
Second Address | Las Cruces, NM 88011-8259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 30/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431084YY54 | MEDICARE PTAN (01) | NM |