Provider Demographics
NPI:1255306098
Name:ZUMWALT, RICHARD D
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:ZUMWALT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6765 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-2305
Mailing Address - Country:US
Mailing Address - Phone:530-872-4326
Mailing Address - Fax:
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:#9
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-872-0617
Practice Address - Fax:530-872-4463
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40946207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G409460Medicaid
CA00G409460Medicaid
A48406Medicare UPIN