Provider Demographics
NPI:1275740557
Name:HONABLUE, RICHARD RIDDICK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RIDDICK
Last Name:HONABLUE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8025 BELROI RD
Mailing Address - Street 2:P. O. BOX 1566
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4300
Mailing Address - Country:US
Mailing Address - Phone:804-693-5528
Mailing Address - Fax:804-695-0298
Practice Address - Street 1:8025 BELROI RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4300
Practice Address - Country:US
Practice Address - Phone:804-693-5528
Practice Address - Fax:804-695-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB06174Medicare UPIN