Provider Demographics
NPI:1245335082
Name:ADLER, RICHARD (PH,D, MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:PH,D, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OCOEE ST.
Mailing Address - Street 2:
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-1020
Mailing Address - Country:US
Mailing Address - Phone:423-496-1643
Mailing Address - Fax:423-496-1144
Practice Address - Street 1:107 OCOEE STREET
Practice Address - Street 2:
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317
Practice Address - Country:US
Practice Address - Phone:423-496-1643
Practice Address - Fax:423-496-1144
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC31080OtherUPIN