Healthcare Provider Details

I. General information

NPI: 1679009666
Provider Name (Legal Business Name): BETHANY RICHARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4425
  • Fax: 505-982-8440
Mailing address:
  • Phone: 505-982-4425
  • Fax: 505-982-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123298
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: