Provider Demographics
NPI:1821294695
Name:COURSEY, RICHARD LYNN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYNN
Last Name:COURSEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE304062085R0202X
KS04-405402085R0202X
HIMD194412085R0202X
ND123002085R0202X, 2085R0204X
CO593532085R0202X
CODR.00593532085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO601958YQN9OtherMEDICARE PIN
KSKA3249103OtherMEDICARE PIN
NENA1214124OtherMEDICARE PIN
CO601958YQ3LOtherMEDICARE PIN
KS111257112OtherMEDICARE PIN
NENA1215125OtherMEDICARE PIN
CO601958YQ33OtherMEDICARE PIN
CO601958YQPGOtherMEDICARE PIN
CO601958ZLJ3OtherMEDICARE PIN
CO601958ZNTBOtherMEDICARE PIN
CO9000153041Medicaid
NENA2517102OtherMEDICARE PIN
ND16893Medicaid
ND717937Medicare PIN