Provider Demographics
NPI:1386602159
Name:CAPE, RICHARD C (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:CAPE
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 1:401 E TICKLE ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3163
Mailing Address - Country:US
Mailing Address - Phone:731-286-2801
Mailing Address - Fax:731-286-0058
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3163
Practice Address - Country:US
Practice Address - Phone:731-286-2801
Practice Address - Fax:731-286-0058
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000021811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3066034Medicaid
TN3066034Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TN3066034Medicaid
TNF20233Medicare UPIN