Healthcare Provider Details

I. General information

NPI: 1588009286
Provider Name (Legal Business Name): EVAN J RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 11/13/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTHUL REGIONAL MEDICAL CENTER UNIT 3310,0
APO AE
09180-3100
US

IV. Provider business mailing address

LANDSTHUL REGIONAL MEDICAL CENTER UNIT 3310,0
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 850-884-1100
  • Fax:
Mailing address:
  • Phone: 850-884-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101256778
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number62619
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20251
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: