Provider Demographics
NPI:1174502090
Name:SERKOWSKI, RICHARD JAMES (DO, MPH, CPE)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:SERKOWSKI
Suffix:
Gender:M
Credentials:DO, MPH, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 J ST BLDG 109
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58205-6332
Mailing Address - Country:US
Mailing Address - Phone:701-747-5547
Mailing Address - Fax:
Practice Address - Street 1:511 N TORCH BLVD
Practice Address - Street 2:BLDG 300
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5109
Practice Address - Country:US
Practice Address - Phone:575-784-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42767-021208D00000X
WI427672083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice