Healthcare Provider Details

I. General information

NPI: 1700827102
Provider Name (Legal Business Name): RICHARD FIELDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BROAD ST
BAXTER TN
38544-5117
US

IV. Provider business mailing address

319 BROAD ST
BAXTER TN
38544-5117
US

V. Phone/Fax

Practice location:
  • Phone: 931-858-2116
  • Fax: 931-858-2117
Mailing address:
  • Phone: 931-858-2116
  • Fax: 931-858-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number17368
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17368
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: