Healthcare Provider Details

I. General information

NPI: 1194301549
Provider Name (Legal Business Name): CHRISTOPHER MARK RICHARDS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

5575 SIMMONS ST STE 1 BOX 563
NORTH LAS VEGAS NV
89031-9008
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-5000
  • Fax:
Mailing address:
  • Phone: 702-582-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number010980
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO3634
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberDO3634
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number010980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: