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NPI Code Detail

MEDICARE: DR. RICHARD LEE ENDORF M.D.

MEDICARE:  DR. RICHARD LEE ENDORF  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
12083A0100XAerospace Medicine Physician22629NE
22085R0202XDiagnostic Radiology PhysicianTL3366WY

General Provider Information

NPI Number : 1871580266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD LEE ENDORF M.D.
Provider Business Mailing Address
First Line : 105 GRANT CIR
Second Line :
City : OFFUTT A F B
State : NE
Zip : 68113-4041
Country : US
Telephone Number : 402-294-7345
Fax Number :
Provider Business Practice Location Address
First Line : 1200 COLLEGE DR
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5868
Country : US
Telephone Number : 307-350-8577
Fax Number : 307-875-8800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 02/17/2016

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Directions to “ DR. RICHARD LEE ENDORF M.D.” Practice Location

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