Provider Demographics
NPI:1245406883
Name:MILLSAP, RICHARD A (CSFA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MILLSAP
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 SE ARBORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2374
Mailing Address - Country:US
Mailing Address - Phone:541-408-7286
Mailing Address - Fax:
Practice Address - Street 1:1951 SE ARBORWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2374
Practice Address - Country:US
Practice Address - Phone:541-408-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant