Provider Demographics
NPI:1831414507
Name:RICHMOND, JEFFREY MICHAEL
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4567
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4567
Mailing Address - Country:US
Mailing Address - Phone:304-460-5123
Mailing Address - Fax:800-734-8498
Practice Address - Street 1:1120 N LINCOLN ST STE 1601
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2141
Practice Address - Country:US
Practice Address - Phone:720-432-9865
Practice Address - Fax:720-528-8042
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00579962084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program