MEDICARE: DR. CARLTON A RICHIE D.O.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	3440	AZ
2	207Q00000X	Family Medicine Physician	3440	AZ

General Provider Information

NPI Number	:	1699770925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON A RICHIE D.O.

Provider Business Mailing Address
First Line	:	7150 E CAMELBACK RD
Second Line	:	SUITE 105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1200
Country	:	US
Telephone Number	:	602-218-4072
Fax Number	:	602-218-4076

Provider Business Practice Location Address
First Line	:	7150 E CAMELBACK RD
Second Line	:	SUITE 105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1200
Country	:	US
Telephone Number	:	602-218-4072
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/14/2025

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