MEDICARE: CHRISTINA G RICHARDS M D P C

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	374408-1205	UT

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	:	1922123694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA G RICHARDS M D P C

Provider Business Mailing Address
First Line	:	1046 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1520
Country	:	US
Telephone Number	:	801-746-2885
Fax Number	:	801-746-2886

Provider Business Practice Location Address
First Line	:	1046 E 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1520
Country	:	US
Telephone Number	:	801-746-2885
Fax Number	:	801-746-2886

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	12/02/2014

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