Provider Demographics
NPI:1225051097
Name:RICHARDS, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1106 DOUGLAS ST
Mailing Address - Street 2:STE D
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2429
Mailing Address - Country:US
Mailing Address - Phone:360-423-9229
Mailing Address - Fax:360-423-9230
Practice Address - Street 1:1106 DOUGLAS ST
Practice Address - Street 2:STE D
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2429
Practice Address - Country:US
Practice Address - Phone:360-423-9229
Practice Address - Fax:360-423-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA15784207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121243Medicaid
WA1121243Medicaid
WA1121243Medicaid