Basic Information
| Provider Information | |||||||||
| NPI: | 1306232541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NANCE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1710 DUVAL STREET | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053940113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1710 14TH ST | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393014140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017031485 | ||||||||
| FaxNumber: | 6017031488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L.4022R | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO.1602 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05001245 | 05 | MS | MEDICAID |