Healthcare Provider Details

I. General information

NPI: 1720609068
Provider Name (Legal Business Name): BRIAN RICHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NEBRASKA AVE
GRANTS PASS OR
97527-5700
US

IV. Provider business mailing address

2780 E BARNETT RD STE 200
MEDFORD OR
97504-8674
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-0603
  • Fax: 541-472-0609
Mailing address:
  • Phone: 541-779-6250
  • Fax: 541-608-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD229251
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: