1992709745 NPI number — DR. ALAN B RICHARDS MD

Table of content: DR. ALAN B RICHARDS MD (NPI 1992709745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992709745 NPI number — DR. ALAN B RICHARDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
ALAN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992709745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 WATERS EDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-7774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-455-5569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 WATERS EDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-7774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-455-5569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  05012R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0110X , with the licence number: MD.05012R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 129700001 . This is a "ARKANSAS MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1305553 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180046317 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1053315846 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 106524503 . This is a "TEXAS MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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