Provider Demographics
NPI:1265421101
Name:COVEY, RICHARD DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:COVEY
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 1:3155 STILLWATER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7151
Mailing Address - Country:US
Mailing Address - Phone:928-777-8000
Mailing Address - Fax:928-777-8104
Practice Address - Street 1:3155 STILLWATER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7151
Practice Address - Country:US
Practice Address - Phone:928-777-8000
Practice Address - Fax:928-777-8104
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080168020OtherMEDICARE RAILROAD
AZ518029Medicaid
AZAZ0879340OtherBC/BS OF ARIZONA
61344Medicare ID - Type Unspecified
AZAZ0879340OtherBC/BS OF ARIZONA