Provider Demographics
NPI:1417070566
Name:LE, RICHARD T (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12611 HESPERIA RD
Mailing Address - Street 2:STE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8307
Mailing Address - Country:US
Mailing Address - Phone:760-951-7762
Mailing Address - Fax:760-951-7134
Practice Address - Street 1:12611 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8307
Practice Address - Country:US
Practice Address - Phone:760-951-7762
Practice Address - Fax:760-951-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12033207Q00000X, 207N00000X
TXN4544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine