Healthcare Provider Details

I. General information

NPI: 1316085855
Provider Name (Legal Business Name): RICHARD EDUARDO REPASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD EDUARDO REPASS MD

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 NE 180TH ST STE 100
BOTHELL WA
98011-5773
US

IV. Provider business mailing address

PO BOX 1775
MERCER ISLAND WA
98040-1775
US

V. Phone/Fax

Practice location:
  • Phone: 425-652-4812
  • Fax: 801-701-8387
Mailing address:
  • Phone: 425-652-4812
  • Fax: 801-701-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50953
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number60341333
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number14238188-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number308708
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41319
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number41319
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number308708
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14238188-1205
License Number StateUT
# 9
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number60341333
License Number StateWA
# 10
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number50953
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: