Healthcare Provider Details

I. General information

NPI: 1174564215
Provider Name (Legal Business Name): MOIRA L M RICHARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5585
  • Fax: 520-324-1848
Mailing address:
  • Phone: 520-324-5461
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number22353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: