Provider Demographics
NPI:1972682433
Name:ABE, RICHARD R (DPM)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:ABE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 N JACKSON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1607
Mailing Address - Country:US
Mailing Address - Phone:408-923-0309
Mailing Address - Fax:408-923-2433
Practice Address - Street 1:280 N JACKSON AVE
Practice Address - Street 2:STE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1607
Practice Address - Country:US
Practice Address - Phone:408-923-0309
Practice Address - Fax:408-923-2433
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1740213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E1740Medicaid
CA000E1740Medicare ID - Type Unspecified
CA000E1740Medicaid