Provider Demographics
NPI:1366001190
Name:AMUNDSEN, RICHARD ARMEN (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARMEN
Last Name:AMUNDSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2600 KANELL BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3001
Mailing Address - Country:US
Mailing Address - Phone:573-785-4546
Mailing Address - Fax:573-785-6959
Practice Address - Street 1:2600 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3001
Practice Address - Country:US
Practice Address - Phone:573-785-4546
Practice Address - Fax:573-785-6959
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT32-2019213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist