Basic Information
Provider Information
NPI: 1275519589
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUSTIN
FirstName: RICHARD
MiddleName: L
NamePrefix:  
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16955 VIA DEL CAMPO
Address2: STE 215
City: SAN DIEGO
State: CA
PostalCode: 92127
CountryCode: US
TelephoneNumber: 8586736100
FaxNumber: 8586736113
Practice Location
Address1: 555 E VALLEY PKWY
Address2: PALOMAR MEDICAL CTR
City: ESCONDIDO
State: CA
PostalCode: 920253048
CountryCode: US
TelephoneNumber: 7607393000
FaxNumber: 7607392926
Other Information
ProviderEnumerationDate: 12/19/2005
LastUpdateDate: 05/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XG85946CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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