Provider Demographics
NPI:1841734035
Name:RICHARD REPASS, MD, PLLC
Entity type:Organization
Organization Name:RICHARD REPASS, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:REPASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-652-4812
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1775
Mailing Address - Country:US
Mailing Address - Phone:425-652-4812
Mailing Address - Fax:425-818-3821
Practice Address - Street 1:2737 78TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2843
Practice Address - Country:US
Practice Address - Phone:425-652-4812
Practice Address - Fax:425-364-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty