Provider Demographics
NPI:1013936533
Name:RICHMOND, BARRY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3029
Mailing Address - Country:US
Mailing Address - Phone:323-566-1183
Mailing Address - Fax:323-566-5348
Practice Address - Street 1:3425 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3029
Practice Address - Country:US
Practice Address - Phone:323-566-1183
Practice Address - Fax:323-566-5348
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2739213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11452Medicare UPIN