Provider Demographics
NPI:1609050749
Name:CARLTON A RICHIE III DO PLC
Entity Type:Organization
Organization Name:CARLTON A RICHIE III DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-751-3771
Mailing Address - Street 1:7349 N VIA PASEO DEL SUR
Mailing Address - Street 2:SUITE 515 #206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3765
Mailing Address - Country:US
Mailing Address - Phone:480-751-3771
Mailing Address - Fax:480-751-3778
Practice Address - Street 1:1840 E BASELINE RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1527
Practice Address - Country:US
Practice Address - Phone:480-751-3771
Practice Address - Fax:480-751-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3440207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1699770925OtherINDIVIDUAL NPI
AZZ105716Medicare PIN
AZ1699770925OtherINDIVIDUAL NPI