MEDICARE: MR. STUART ALAN RICHARDS PA-C

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	363A00000X	Physician Assistant	AZ1422	AZ

General Provider Information

NPI Number	:	1609824739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STUART ALAN RICHARDS PA-C

Provider Business Mailing Address
First Line	:	2952 N ELLIS ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1774
Country	:	US
Telephone Number	:	480-759-4901
Fax Number	:

Provider Business Practice Location Address
First Line	:	US DEPT OF STATE MED Q1 SA 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20522-0102
Country	:	US
Telephone Number	:	202-663-1519
Fax Number	:	202-663-3247

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/13/2015

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