Provider Demographics
NPI:1932106853
Name:CARDONE, RICHARD AUGUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:AUGUSTINE
Last Name:CARDONE
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:PO BOX 9687
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86427-9687
Mailing Address - Country:US
Mailing Address - Phone:928-768-4100
Mailing Address - Fax:928-768-6522
Practice Address - Street 1:5300 HWY 95
Practice Address - Street 2:STE. C
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-768-4100
Practice Address - Fax:928-768-6522
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26223208600000X
CAG84346208C00000X
PAMD050553L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ415390Medicaid
AZ415390Medicaid
G65261Medicare UPIN
AZZ25057Medicare PIN