Provider Demographics
NPI:1376533638
Name:ANDOLSEN, RICHARD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:ANDOLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:465 MARCH AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3371
Mailing Address - Country:US
Mailing Address - Phone:707-433-3369
Mailing Address - Fax:707-433-7013
Practice Address - Street 1:465 MARCH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3371
Practice Address - Country:US
Practice Address - Phone:707-433-3369
Practice Address - Fax:707-433-7013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG31940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G319400Medicaid
CA00G319400Medicaid
CA00G319400Medicare ID - Type Unspecified