Provider Demographics
NPI:1700827102
Name:FIELDS, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FIELDS
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 1:319 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-5117
Mailing Address - Country:US
Mailing Address - Phone:931-858-2116
Mailing Address - Fax:931-858-2117
Practice Address - Street 1:319 BROAD ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-5117
Practice Address - Country:US
Practice Address - Phone:931-858-2116
Practice Address - Fax:931-858-2117
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17368207QA0505X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023449Medicaid
KY50014552OtherPASSPORT
KY64008857Medicaid
TN3144641OtherBCBS OF TN
TNP00327914OtherRAILROAD MEDICARE
TNA98734Medicare UPIN
TN3023449Medicaid