Provider Demographics
NPI:1275861734
Name:RICHARDS, PHILLIP OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:OLIVER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:45546 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-6150
Mailing Address - Country:US
Mailing Address - Phone:760-345-8904
Mailing Address - Fax:760-345-8510
Practice Address - Street 1:45546 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-6150
Practice Address - Country:US
Practice Address - Phone:760-345-8904
Practice Address - Fax:760-345-8510
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301029346207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine