Provider Demographics
NPI:1245211028
Name:RICHIE, BUNNIE F (DO)
Entity Type:Individual
Prefix:MRS
First Name:BUNNIE
Middle Name:F
Last Name:RICHIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7349 N VIA PASEO DEL SUR
Mailing Address - Street 2:SUITE 515 #206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3765
Mailing Address - Country:US
Mailing Address - Phone:480-751-3771
Mailing Address - Fax:602-482-2982
Practice Address - Street 1:9075 N 103RD PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5701
Practice Address - Country:US
Practice Address - Phone:480-298-2620
Practice Address - Fax:480-699-2329
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1649469586OtherGROUP NPI
90-0121799OtherTIN
AZG94863Medicare UPIN