Provider Demographics
NPI:1215976188
Name:MAILLOUX, RICHARD J (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:MAILLOUX
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Gender:M
Credentials:MD
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Mailing Address - Street 1:DR. RICHARD MAILLOUX
Mailing Address - Street 2:198 CARRIAGE DRIVE
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2804
Mailing Address - Country:US
Mailing Address - Phone:304-256-4348
Mailing Address - Fax:681-207-5101
Practice Address - Street 1:DR. RICHARD MAILLOUX
Practice Address - Street 2:198 CARRIAGE DRIVE
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2804
Practice Address - Country:US
Practice Address - Phone:304-256-4348
Practice Address - Fax:681-207-5101
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV18094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000691895OtherANTHEM BCBS
110103523OtherRAILROAD MEDICARE
WV0088257000Medicaid
OH0151526OtherMEDICAID
KY64072697Medicaid
KY000000691895OtherANTHEM BCBS
110103523OtherRAILROAD MEDICARE
E91409Medicare UPIN