Provider Demographics
NPI:1992726509
Name:RICHARDS, DOUGLAS S (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOULGAS
Other - Middle Name:SPENCER
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-507-7400
Mailing Address - Fax:801-507-7494
Practice Address - Street 1:5121 COTTONWOOD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7400
Practice Address - Fax:801-507-7494
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168778-1205207VM0101X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046658100Medicaid
FL68440ZMedicare PIN
C86144Medicare UPIN