Provider Demographics
NPI:1730263716
Name:RICH, STEPHEN M (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8465 OLD REDWOOD HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9244
Mailing Address - Country:US
Mailing Address - Phone:707-433-5494
Mailing Address - Fax:707-837-0119
Practice Address - Street 1:8465 OLD REDWOOD HWY STE 320
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492
Practice Address - Country:US
Practice Address - Phone:707-433-5494
Practice Address - Fax:707-837-0119
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G409220Medicaid
F10893Medicare UPIN
00G409220Medicare ID - Type Unspecified