Provider Demographics
NPI:1740250026
Name:SADLER, RICHARD LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:SADLER
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 1:3385 DEXTER CT STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-324-3818
Mailing Address - Fax:563-326-4280
Practice Address - Street 1:3385 DEXTER CT STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-324-3818
Practice Address - Fax:563-326-4280
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2284216Medicaid
IA2284216Medicaid
IAI5313Medicare ID - Type Unspecified