Provider Demographics
NPI:1093551103
Name:RICHARD, TOBY AARON
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:AARON
Last Name:RICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LOCK AND DAM RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9725
Mailing Address - Country:US
Mailing Address - Phone:479-567-5530
Mailing Address - Fax:
Practice Address - Street 1:104 LOCK AND DAM RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9725
Practice Address - Country:US
Practice Address - Phone:479-567-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator