Basic Information
Provider Information
NPI: 1750939781
EntityType: 2
ReplacementNPI:  
OrganizationName: JEROME RICHARDS MD INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7417 N CEDAR AVE
Address2:  
City: FRESNO
State: CA
PostalCode: 937203637
CountryCode: US
TelephoneNumber: 5594360871
FaxNumber: 5594365221
Practice Location
Address1: 609 E ORANGEBURG AVE BLDG B
Address2:  
City: MODESTO
State: CA
PostalCode: 953505512
CountryCode: US
TelephoneNumber: 5594360871
FaxNumber: 5594365221
Other Information
ProviderEnumerationDate: 09/03/2019
LastUpdateDate: 09/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RICHARDS
AuthorizedOfficialFirstName: JEROME
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5594375645
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home