MEDICARE: DAVID TAYLOR RICHARDS M.D.

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	208600000X	Surgery Physician	5586768-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	005770801/000057708	OTHER	UT	MEDICARE, UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	558768120001	OTHER	UT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396853206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID TAYLOR RICHARDS M.D.

Provider Business Mailing Address
First Line	:	5249 GRAVENSTEIN PARK
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-4562
Country	:	US
Telephone Number	:	801-262-2830
Fax Number	:	888-893-1576

Provider Business Practice Location Address
First Line	:	175 N 100 W
Second Line	:	STE 202
City	:	VERNAL
State	:	UT
Zip	:	84078-2049
Country	:	US
Telephone Number	:	435-789-4180
Fax Number	:	435-781-1185

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/10/2011

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