Provider Demographics
NPI:1194772996
Name:SUDDATH, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SUDDATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 WALNUT STREET
Mailing Address - Street 2:204
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302
Mailing Address - Country:US
Mailing Address - Phone:303-444-3443
Mailing Address - Fax:303-444-7228
Practice Address - Street 1:2501 WALNUT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5751
Practice Address - Country:US
Practice Address - Phone:303-444-7228
Practice Address - Fax:303-442-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR257052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
87891Medicare ID - Type Unspecified