Provider Demographics
NPI:1629324322
Name:SPEES, RICHARD SCOTT (IDC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:SPEES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 51ST ST # STREET3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3460
Mailing Address - Country:US
Mailing Address - Phone:810-955-3053
Mailing Address - Fax:
Practice Address - Street 1:4520 51ST ST # STREET3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3460
Practice Address - Country:US
Practice Address - Phone:810-955-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman