Healthcare Provider Details

I. General information

NPI: 1760060784
Provider Name (Legal Business Name): ZACHARY JOSEPH RICHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5387 MANHATTAN CIR STE 200
BOULDER CO
80303-4283
US

IV. Provider business mailing address

5387 MANHATTAN CIR STE 200
BOULDER CO
80303-4283
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number333171
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number333171
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0074781
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0074781
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: