Provider Demographics
NPI:1881789352
Name:ELLIOTT, RICHARD SCHINDLER (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCHINDLER
Last Name:ELLIOTT
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 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:13640 NORTH PLAZA DEL RIO BLVD.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-876-3800
Practice Address - Fax:623-972-9590
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131185Medicare PIN
AZZ112087Medicare PIN
AZP00366759Medicare PIN
NEA42302Medicare UPIN
AZZ112088Medicare PIN