Provider Demographics
NPI:1386192961
Name:CHRISTINA G RICHARDS MD PC
Entity Type:Organization
Organization Name:CHRISTINA G RICHARDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-746-2885
Mailing Address - Street 1:1046 E 100 S
Mailing Address - Street 2:STE. 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1520
Mailing Address - Country:US
Mailing Address - Phone:801-746-2885
Mailing Address - Fax:
Practice Address - Street 1:1046 E 100 S
Practice Address - Street 2:STE. 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1520
Practice Address - Country:US
Practice Address - Phone:801-746-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3744081205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty