Provider Demographics
NPI:1609845775
Name:RICHARDS, SPENCER E (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:E
Last Name:RICHARDS
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-298-2495
Mailing Address - Fax:801-298-2801
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6136
Practice Address - Country:US
Practice Address - Phone:801-298-2495
Practice Address - Fax:801-298-2801
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58953691205204C00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854058788-D6150Medicaid
UTI31070Medicare UPIN
000060245Medicare PIN
UT000063605Medicare PIN
005532645Medicare PIN
000060244Medicare PIN
UT942854058788-D6150Medicaid
000060246Medicare PIN
000060247Medicare PIN
000060272Medicare PIN
000060510Medicare PIN
UT000060241Medicare PIN