Provider Demographics
NPI:1164419677
Name:KOURI, RICHARD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:KOURI
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 1:1715 N WEBER ST STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7524
Mailing Address - Country:US
Mailing Address - Phone:719-577-4200
Mailing Address - Fax:719-442-6595
Practice Address - Street 1:1715 N WEBER ST STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7524
Practice Address - Country:US
Practice Address - Phone:719-577-4200
Practice Address - Fax:719-442-6595
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01206192Medicaid
344538Medicare ID - Type Unspecified
CO01206192Medicaid