Healthcare Provider Details

I. General information

NPI: 1962446401
Provider Name (Legal Business Name): RICHARD G HANLEY I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S 3RD ST
MONTROSE CO
81401-4209
US

IV. Provider business mailing address

715 S 3RD ST
MONTROSE CO
81401-4209
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-6737
  • Fax: 970-252-0112
Mailing address:
  • Phone: 970-249-6737
  • Fax: 970-252-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28740
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number28470
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: