Provider Demographics
NPI:1548249311
Name:RICHARDS, LEONARD S (DO)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2350
Mailing Address - Country:US
Mailing Address - Phone:515-263-5000
Mailing Address - Fax:515-263-5001
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316
Practice Address - Country:US
Practice Address - Phone:515-263-5000
Practice Address - Fax:515-263-5001
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA027282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA120002172OtherRR MEDICARE
IA1548249311Medicaid
IA0122267Medicaid
IA0122267Medicaid
IA59454Medicare PIN