Provider Demographics
NPI:1013979525
Name:NUSSER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:NUSSER
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 1:411 30TH ST STE 314
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3312
Mailing Address - Country:US
Mailing Address - Phone:510-465-6800
Mailing Address - Fax:510-268-0634
Practice Address - Street 1:411 30TH ST STE 314
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3312
Practice Address - Country:US
Practice Address - Phone:510-465-6800
Practice Address - Fax:510-268-0634
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC337330207RC0200X, 207RN0300X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C337330Medicaid
A35366Medicare UPIN
CA00C337330Medicare ID - Type Unspecified