Provider Demographics
NPI:1093780561
Name:TREPETA, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:TREPETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-2210
Mailing Address - Country:US
Mailing Address - Phone:623-266-7770
Mailing Address - Fax:623-322-4639
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-263-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16208207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZAZ0828960OtherBCBSAZ-SUN CITY PATH
AZ111279Medicaid
AZAZ0182900OtherBCBSAZ-PATH ASSOC
AZAX4478OtherHEALTH NET AZ-PATH ASSOC
AZAZ0182900OtherBCBSAZ-PATH ASSOC
AZZ23886Medicare PIN
AZAZ0828960OtherBCBSAZ-SUN CITY PATH
AZ111279Medicaid
AZ220010579Medicare PIN
AZ131464Medicare PIN