MEDICARE: MRS. BUNNIE F RICHIE D.O.

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	2084N0400X	Neurology Physician	3422	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649469586	OTHER	AZ	GROUP NPI

General Provider Information

NPI Number	:	1245211028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BUNNIE F RICHIE D.O.

Provider Business Mailing Address
First Line	:	7349 N VIA PASEO DEL SUR
Second Line	:	SUITE 515 #206
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3765
Country	:	US
Telephone Number	:	480-751-3771
Fax Number	:	602-482-2982

Provider Business Practice Location Address
First Line	:	9075 N 103RD PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-5701
Country	:	US
Telephone Number	:	480-298-2620
Fax Number	:	480-699-2329

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	04/24/2015

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