Provider Demographics
NPI:1659441491
Name:CARVER, RICHARD FREDERICK (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:CARVER
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 1:7236 JORDAN DRIVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8734
Mailing Address - Country:US
Mailing Address - Phone:605-343-0495
Mailing Address - Fax:605-342-2272
Practice Address - Street 1:7236 JORDAN DRIVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8734
Practice Address - Country:US
Practice Address - Phone:605-343-0495
Practice Address - Fax:605-342-2272
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3560208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0002400OtherBCBS
SD7301330Medicaid
SD3560OtherDAKOTACARE
SD3560OtherDAKOTACARE
SDC94760Medicare UPIN