Provider Demographics
NPI:1174509988
Name:PAUL, RICHARD DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:PAUL
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 1:7955 26 WISTFUL VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-537-9456
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-5722
Practice Address - Fax:515-241-4403
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18423207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0119OtherJOHN DEERE PROVIDER #
IA18423OtherTRICARE PROVIDER #
IA4264OtherMIDLANDS PROVIDER #
IA0085266Medicaid
IA08526OtherBLUE SHIELD PROVIDER #
IA08526Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
IA0085266Medicaid