Provider Demographics
NPI:1346246303
Name:RICHARD, SAMUEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:W
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8904
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-8904
Mailing Address - Country:US
Mailing Address - Phone:360-887-9494
Mailing Address - Fax:360-887-9498
Practice Address - Street 1:8507 SOUTH 5TH STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:360-887-9498
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD45571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C94492Medicare UPIN
WA8856199Medicare PIN
ORR113558Medicare PIN