Provider Demographics
NPI:1205878113
Name:RICHE, ANDREW BALFORD (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BALFORD
Last Name:RICHE
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 10930
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0930
Mailing Address - Country:US
Mailing Address - Phone:479-785-2229
Mailing Address - Fax:479-478-6745
Practice Address - Street 1:3224 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5050
Practice Address - Country:US
Practice Address - Phone:479-785-2229
Practice Address - Fax:479-478-6745
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2520207V00000X
LAMD.200550207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143634001Medicaid
AR5L860Medicare ID - Type Unspecified
AR143634001Medicaid