Healthcare Provider Details

I. General information

NPI: 1255306098
Provider Name (Legal Business Name): RICHARD D ZUMWALT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6283 CLARK RD #9
PARADISE CA
95969-4100
US

IV. Provider business mailing address

6765 CHAPMAN LN
PARADISE CA
95969-2305
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-0617
  • Fax: 530-872-4463
Mailing address:
  • Phone: 530-872-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG40946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: