Provider Demographics
NPI:1265437305
Name:PINON, RICHARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PINON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 W COUNTRY CLUB RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5240
Mailing Address - Country:US
Mailing Address - Phone:575-622-1411
Mailing Address - Fax:575-624-5630
Practice Address - Street 1:300 W COUNTRY CLUB RD STE 230
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5240
Practice Address - Country:US
Practice Address - Phone:575-622-1411
Practice Address - Fax:575-624-5630
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNPI & TINOtherBCBS OF NM
NMNM014491OtherBCBS
NMT4798Medicaid
NMG74978Medicare UPIN
NM343421802Medicare PIN