MEDICARE: JOHN E RICHARDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	15784	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225051097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E RICHARDS M.D.

Provider Business Mailing Address
First Line	:	1106 DOUGLAS ST
Second Line	:	STE D
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2429
Country	:	US
Telephone Number	:	360-423-9229
Fax Number	:	360-423-9230

Provider Business Practice Location Address
First Line	:	1106 DOUGLAS ST
Second Line	:	STE D
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2429
Country	:	US
Telephone Number	:	360-423-9229
Fax Number	:	360-423-9230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/21/2017

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