Provider Demographics
NPI:1962493338
Name:HEUSER, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:HEUSER
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 1:1331 N 7TH ST
Mailing Address - Street 2:STE 375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2707
Mailing Address - Country:US
Mailing Address - Phone:602-307-0070
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 900
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-234-0004
Practice Address - Fax:602-234-0058
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296641Medicaid
AZC97833Medicare UPIN
AZ296641Medicaid