Provider Demographics
NPI:1841398211
Name:MANDEL, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29675
Mailing Address - Street 2:DEPARTMENT 2084
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9675
Mailing Address - Country:US
Mailing Address - Phone:520-318-9681
Mailing Address - Fax:520-325-6774
Practice Address - Street 1:5230 E FARNESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2141
Practice Address - Country:US
Practice Address - Phone:520-318-9681
Practice Address - Fax:520-325-6774
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14771207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249905Medicaid
AZ110068970OtherRAILROAD MEDICARE
AZ249905Medicaid
AZ110068970OtherRAILROAD MEDICARE