Doctor Name: | DR. RICHARD SUDDATH |
NPI Number: | 1194772996 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 2501 Walnut St Suite 204 Boulder, CO - 803025751 |
Business Phone Number: | 3034447228 |
Business Fax Number: | 3034421125 |
Mailing Address: | Po Box 2086, FORT COLLINS |
State: | CO |
Postal Code: | 805222086 |
Phone Number: | 3034443443 |
Fax Number: | 9702213730 |
NPI Enumeration Date: | 05/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |