Provider Demographics
NPI:1427085042
Name:VETTER, RICHARD T (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:VETTER
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1401 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-5751
Practice Address - Fax:701-364-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5800207Q00000X
MN33414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0112632OtherMEDICA #
ND16246Medicaid
ND3M183VEOtherMNBS #
NDND100034OtherLHS #
MN2M009VEOtherMNBS #
NDDA9011015649OtherPREFERRED ONE #
ND676662OtherAMERICA'S PPO/ARAZ #
ND0105985OtherMEDICA #
ND0C304VEOtherMNBS #
ND55A99VEOtherMNBS #
NDHP19558OtherHEALTHPARTNERS #
ND251398600Medicaid
ND0108145OtherMEDICA #
ND0C305VEOtherMNBS #
ND111861OtherUCARE #
ND3M183VEOtherMNBS #
ND10814Medicare ID - Type UnspecifiedND MEDICARE #
ND0890010751Medicare ID - Type UnspecifiedMN MEDICARE #
MN2M009VEOtherMNBS #
ND0C305VEOtherMNBS #