Provider Demographics
NPI:1457394199
Name:NEVILLE, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:NEVILLE
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 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-977-4479
Mailing Address - Fax:623-977-4497
Practice Address - Street 1:13128 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4252
Practice Address - Country:US
Practice Address - Phone:623-259-5900
Practice Address - Fax:833-766-3364
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313940-01Medicaid
AZAZ0378280OtherBLUE CROSS/BLUE SHIELD ID #
AZIZ1738OtherHEALTHNET ID #
AZ4216993OtherAETNA ID #
AZAZ0378280OtherBLUE CROSS/BLUE SHIELD ID #
AZ4216993OtherAETNA ID #
AZ77000081Medicare PIN