Provider Demographics
NPI:1467440115
Name:DAUPHINE, RICHARD TIERNEY (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TIERNEY
Last Name:DAUPHINE
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 CASS ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4548
Mailing Address - Country:US
Mailing Address - Phone:831-375-2489
Mailing Address - Fax:831-375-5824
Practice Address - Street 1:980 CASS ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4548
Practice Address - Country:US
Practice Address - Phone:831-375-2489
Practice Address - Fax:831-375-5824
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 22565207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABBND AD 7010919OtherDRUG PRESCRIBING NUMBER
CAG 22565OtherMEDICAL LICENCE NO.
CAEIN 94-2497419OtherMEDICAL CORPORATION