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General NPI Number Information
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NPI Number | 1679550081
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Entity Type | Individual
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Provider Name | RICHARD L GRIES MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 304 E HWY 68
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City | HAUBSTADT
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State | IN
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Zip | 47639
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Country | US
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Telephone | 812-464-3016
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Fax | 812-753-4148
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | HAUBSTADT
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State | IN
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Zip | 47639-0370
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Country | US
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Telephone | 812-464-3016
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Fax | 812-753-4148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01024530A
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License Number State | IN
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