MEDICARE: DR. JAMES RANDALL RICHARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35044926	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023110335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RANDALL RICHARD MD

Provider Business Mailing Address
First Line	:	2221 HAYES AVE # 2
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/28/2021

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