Provider Demographics
NPI:1285615070
Name:SNURE, RICHARD ROLAND (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROLAND
Last Name:SNURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1327
Mailing Address - Country:US
Mailing Address - Phone:520-432-6484
Mailing Address - Fax:
Practice Address - Street 1:101 COLE AVE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1327
Practice Address - Country:US
Practice Address - Phone:520-432-6484
Practice Address - Fax:520-432-6484
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0779208600000X
AZ31912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59206870Medicaid
NM59206870Medicaid
NM333522300Medicare ID - Type Unspecified