Provider Demographics
NPI:1457467250
Name:RICHMOND, JAMES DEAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DEAN
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000B S MAIN ST
Mailing Address - Street 2:PO BOX 1507
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9572
Mailing Address - Country:US
Mailing Address - Phone:641-472-4156
Mailing Address - Fax:641-472-9436
Practice Address - Street 1:2000B S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9572
Practice Address - Country:US
Practice Address - Phone:641-472-4156
Practice Address - Fax:641-472-9436
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001289363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI5460Medicare ID - Type UnspecifiedPERSONAL IDENTIFICATION #
IAP29177Medicare UPIN