Healthcare Provider Details

I. General information

NPI: 1609050749
Provider Name (Legal Business Name): CARLTON A RICHIE III DO PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E BASELINE RD SUITE C-2
TEMPE AZ
85283-1527
US

IV. Provider business mailing address

7349 N VIA PASEO DEL SUR SUITE 515 #206
SCOTTSDALE AZ
85258-3765
US

V. Phone/Fax

Practice location:
  • Phone: 480-751-3771
  • Fax: 480-751-3778
Mailing address:
  • Phone: 480-751-3771
  • Fax: 480-751-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CARLTON A RICHIE
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 480-751-3771