Provider Demographics
NPI:1063551695
Name:RICHARDS, RAY STAYNER (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:STAYNER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:S
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:SUITE #306
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1500
Mailing Address - Country:US
Mailing Address - Phone:801-359-8956
Mailing Address - Fax:801-355-5250
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:BUILDING C
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-627-5327
Practice Address - Fax:435-627-5306
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181603-12052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E42236Medicare UPIN