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: N

Provider Other Name: RICHARD EDUARDO REPASS MD

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 4TH AVE FL 2
YAKIMA WA
98902-3546
US

IV. Provider business mailing address

402 S 4TH AVE FL 2
YAKIMA WA
98902-3546
US

V. Phone/Fax

Practice location:
  • Phone: 509-572-4084
  • Fax:
Mailing address:
  • Phone: 509-572-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number60341333
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50953
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number60341333
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: