Provider Demographics
NPI:1659407716
Name:OEHLSCHLAGER, RICHARD KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:OEHLSCHLAGER
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 1:3036 LAKEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5240
Mailing Address - Country:US
Mailing Address - Phone:208-363-0108
Mailing Address - Fax:208-388-4517
Practice Address - Street 1:3036 LAKEWOOD WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5240
Practice Address - Country:US
Practice Address - Phone:208-363-0108
Practice Address - Fax:208-388-4517
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7096207RP1001X
CAC-31622207RP1001X
TXD-1757207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134900Medicare ID - Type UnspecifiedMEDICARE
A-34648Medicare UPIN