Provider Demographics
NPI:1689811440
Name:TIRRELL, RICHARD EARNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EARNEST
Last Name:TIRRELL
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 1:6367 NEWHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3862
Mailing Address - Country:US
Mailing Address - Phone:707-649-8224
Mailing Address - Fax:
Practice Address - Street 1:6367 NEWHAVEN LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3862
Practice Address - Country:US
Practice Address - Phone:707-649-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33339207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology