MEDICARE: DR. CHARLOTTE JEAN RICHARDS MD

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	207V00000X	Obstetrics & Gynecology Physician	59904	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z92837	OTHER	AZ	MEDICARE PTAN

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	:	1851358857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE JEAN RICHARDS MD

Provider Business Mailing Address
First Line	:	PO BOX 617
Second Line	:
City	:	SOMERTON
State	:	AZ
Zip	:	85350-0617
Country	:	US
Telephone Number	:	928-662-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1896 E BABBIT LANE
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-1669
Country	:	US
Telephone Number	:	928-722-6112
Fax Number	:	928-722-6113

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/13/2024

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