Provider Demographics
NPI:1164579199
Name:BOOK, RICHARD KENT (DO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENT
Last Name:BOOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAJUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050
Mailing Address - Country:US
Mailing Address - Phone:719-383-2325
Mailing Address - Fax:719-383-2327
Practice Address - Street 1:2317 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LAJUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050
Practice Address - Country:US
Practice Address - Phone:719-383-2325
Practice Address - Fax:719-383-2327
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01318344Medicaid
CO445608Medicare ID - Type Unspecified
F58535Medicare UPIN