Provider Demographics
NPI:1013956838
Name:RICHIE, DOUGLAS H JR (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:RICHIE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PACIFIC COAST HWY
Mailing Address - Street 2:#209
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5999
Mailing Address - Country:US
Mailing Address - Phone:562-493-2451
Mailing Address - Fax:562-596-3157
Practice Address - Street 1:550 PACIFIC COAST HWY
Practice Address - Street 2:#209
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5999
Practice Address - Country:US
Practice Address - Phone:562-493-2451
Practice Address - Fax:562-596-3157
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2669213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4389240001Medicare NSC
CAT11433Medicare UPIN
CAWE2669AMedicare PIN