Healthcare Provider Details

I. General information

NPI: 1417039256
Provider Name (Legal Business Name): RICHARD D FITCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88709 486TH AVE
ONEILL NE
68763-5752
US

IV. Provider business mailing address

1000 W 4TH ST SUITE 12
YANKTON SD
57078-3730
US

V. Phone/Fax

Practice location:
  • Phone: 402-336-3094
  • Fax: 402-336-3776
Mailing address:
  • Phone: 605-668-8704
  • Fax: 605-668-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11972
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: