Provider Demographics
NPI:1730181462
Name:RICHEY, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RICHEY
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 1:1200 AIRPORT HEIGHTS DR
Mailing Address - Street 2:STE 205
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2965
Mailing Address - Country:US
Mailing Address - Phone:907-272-4443
Mailing Address - Fax:907-272-2262
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:STE 205
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2965
Practice Address - Country:US
Practice Address - Phone:907-272-4443
Practice Address - Fax:907-272-2262
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3291207V00000X
TXH6545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1340Medicaid
E32581Medicare UPIN
40BKTBDMedicare ID - Type Unspecified