Provider Demographics
NPI:1023038924
Name:HARVEY, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 DIAMOND VALLEY RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:MARKLEEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96120-9532
Mailing Address - Country:US
Mailing Address - Phone:530-694-2146
Mailing Address - Fax:530-694-2770
Practice Address - Street 1:75 DIAMOND VALLEY RD
Practice Address - Street 2:UNIT B
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9532
Practice Address - Country:US
Practice Address - Phone:530-694-2146
Practice Address - Fax:530-694-2770
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41797Medicare UPIN
00G229745Medicare PIN