Healthcare Provider Details

I. General information

NPI: 1346298833
Provider Name (Legal Business Name): PEACHES ANN RICHARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE MCCHORD CLINIC, MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431
US

IV. Provider business mailing address

10254 SENTINEL LOOP
GIG HARBOR WA
98332-5104
US

V. Phone/Fax

Practice location:
  • Phone: 253-982-0328
  • Fax: 253-982-0158
Mailing address:
  • Phone: 818-693-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01057101A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: