Healthcare Provider Details

I. General information

NPI: 1730387895
Provider Name (Legal Business Name): RICHARD VATT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5301 VIRGINIA WAY SUITE 200
BRENTWOOD TN
37027-7541
US

IV. Provider business mailing address

5301 VIRGINIA WAY SUITE 200
BRENTWOOD TN
37027-7541
US

V. Phone/Fax

Practice location:
  • Phone: 630-263-3050
  • Fax:
Mailing address:
  • Phone: 630-263-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDO 1250
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: