Provider Demographics
NPI:1609824739
Name:RICHARDS, STUART ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:ALAN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2952 N ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1774
Mailing Address - Country:US
Mailing Address - Phone:480-759-4901
Mailing Address - Fax:
Practice Address - Street 1:US DEPT OF STATE MED Q1 SA 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:202-663-1519
Practice Address - Fax:202-663-3247
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS83645Medicare UPIN
AZZ28083Medicare PIN