Provider Demographics
NPI:1265458335
Name:PRICE, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:PRICE
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 1:1304 N ACADEMY BLVD
Mailing Address - Street 2:#204
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3325
Mailing Address - Country:US
Mailing Address - Phone:719-637-0005
Mailing Address - Fax:719-637-0006
Practice Address - Street 1:1304 N ACADEMY BLVD
Practice Address - Street 2:#204
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3325
Practice Address - Country:US
Practice Address - Phone:719-637-0005
Practice Address - Fax:719-637-0006
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01184605Medicaid
CO01184605Medicaid
CO74261Medicare ID - Type Unspecified