Provider Demographics
NPI:1841278454
Name:RIECHERS, THOMAS BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRADLEY
Last Name:RIECHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3135
Mailing Address - Country:US
Mailing Address - Phone:636-861-7870
Mailing Address - Fax:636-861-7899
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-861-7870
Practice Address - Fax:636-861-7899
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103197208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
272481555OtherGREAT WEST
MO331394OtherGROUP HEALTH PLAN
MO3514OtherHEALTHCARE USA
MOP00640364OtherRAILROAD MEDICARE
MO221032OtherANTHEM BLUE CROSS AND BLUE SHIELD
272481555OtherMULTIPLAN
MO206703100Medicaid
MO888890OtherMERCY CARE PLUS
272481555OtherPHCS
272481555OtherHFN
MO224979OtherHEALTHLINK
272481555OtherCHOICECARE
MO4405391OtherAETNA
MO206703100Medicaid
272481555OtherCHOICECARE
MOMA2536002Medicare PIN