Provider Demographics
NPI:1588638951
Name:TEMBLADOR, RICHARD WILLIAM (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:TEMBLADOR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:25 NORTH JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0819
Mailing Address - Country:US
Mailing Address - Phone:910-897-6423
Mailing Address - Fax:910-694-0254
Practice Address - Street 1:25 NORTH JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521-0819
Practice Address - Country:US
Practice Address - Phone:910-897-6423
Practice Address - Fax:910-897-2540
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6508AMedicare PIN