Provider Demographics
NPI:1649469586
Name:BUNNIE F RICHIE DO PLC
Entity type:Organization
Organization Name:BUNNIE F RICHIE DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BUNNIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-482-2122
Mailing Address - Street 1:7349 N VIA PASEO DEL SUR
Mailing Address - Street 2:SUITE 515 #206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3765
Mailing Address - Country:US
Mailing Address - Phone:602-482-2122
Mailing Address - Fax:602-482-2982
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-482-2122
Practice Address - Fax:602-482-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77987Medicare PIN
AZG94863Medicare UPIN