Provider Demographics
NPI:1548304405
Name:EBY, RICHARD S (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:EBY
Suffix:
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 1:3603 E RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1247
Mailing Address - Country:US
Mailing Address - Phone:423-622-2663
Mailing Address - Fax:423-622-8172
Practice Address - Street 1:3603 E RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-1247
Practice Address - Country:US
Practice Address - Phone:423-622-2663
Practice Address - Fax:423-622-8172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000238213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351059Medicaid
TN6364350002OtherPTAN
TN3351059Medicaid
TN3351059Medicare ID - Type Unspecified
TN6364350001Medicare NSC