Provider Demographics
NPI:1194037515
Name:JUEL, RICHARD DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DALE
Last Name:JUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574-0829
Mailing Address - Country:US
Mailing Address - Phone:505-955-9680
Mailing Address - Fax:505-955-8989
Practice Address - Street 1:157 TESUQUE VILLAGE RD
Practice Address - Street 2:
Practice Address - City:TESUQUE
Practice Address - State:NM
Practice Address - Zip Code:87574-0829
Practice Address - Country:US
Practice Address - Phone:505-955-9680
Practice Address - Fax:505-955-8989
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75-58207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17655Medicare UPIN