Provider Demographics
NPI:1487632840
Name:EMTMAN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:EMTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3845
Mailing Address - Country:US
Mailing Address - Phone:509-332-3548
Mailing Address - Fax:509-332-5253
Practice Address - Street 1:915 NE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3845
Practice Address - Country:US
Practice Address - Phone:509-332-3548
Practice Address - Fax:509-332-5253
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1328103Medicaid
WA1328103Medicaid
A07174Medicare UPIN