Provider Demographics
NPI:1932198967
Name:AGUILAR, RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:AGUILAR
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 1:215 E HAWAII AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6011
Mailing Address - Country:US
Mailing Address - Phone:208-463-3000
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:215 E HAWAII AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6011
Practice Address - Country:US
Practice Address - Phone:208-468-5930
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6315208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID45120OtherBLUE CROSS
ID002362800Medicaid
ID570002669OtherRAILROAD MEDICARE
IDD6326OtherBLUE CROSS
ID000010002634OtherBLUE SHIELD
ID000010034806OtherBLUE SHIELD
ID806352700OtherHEALTHY CONNECTIONS
ID002362800Medicaid
ID000010034806OtherBLUE SHIELD
ID806352700OtherHEALTHY CONNECTIONS