Provider Demographics
NPI:1598785826
Name:BREEDEN, RICHARD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:BREEDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3401 N BUTLER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6867
Mailing Address - Country:US
Mailing Address - Phone:505-716-4180
Mailing Address - Fax:505-325-1365
Practice Address - Street 1:2300 E 30TH ST
Practice Address - Street 2:STE B-102
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-609-6790
Practice Address - Fax:505-599-4640
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-142084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00069631Medicaid
NM00069631Medicaid
NM349425201Medicare ID - Type Unspecified