Provider Demographics
NPI:1225011794
Name:RICHARDS, JOHN CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRIS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10362
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162-0362
Mailing Address - Country:US
Mailing Address - Phone:530-320-1693
Mailing Address - Fax:530-587-4634
Practice Address - Street 1:10038 MEADOW WAY
Practice Address - Street 2:UNIT D
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4974
Practice Address - Country:US
Practice Address - Phone:530-587-4634
Practice Address - Fax:530-587-4634
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55548207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G555480Medicaid
E93737Medicare UPIN
CA00G555480Medicaid