Healthcare Provider Details

I. General information

NPI: 1699770925
Provider Name (Legal Business Name): CARLTON A RICHIE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 E CAMELBACK RD SUITE 105
SCOTTSDALE AZ
85251-1200
US

IV. Provider business mailing address

7150 E CAMELBACK RD SUITE 105
SCOTTSDALE AZ
85251-1200
US

V. Phone/Fax

Practice location:
  • Phone: 602-218-4072
  • Fax: 415-252-7176
Mailing address:
  • Phone: 602-218-4072
  • Fax: 602-218-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3440
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: