Provider Demographics
NPI:1174532790
Name:PRICE, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PRICE
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 1:230 TRACE COLONY STE 2
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8810
Mailing Address - Country:US
Mailing Address - Phone:601-992-3996
Mailing Address - Fax:601-414-0221
Practice Address - Street 1:230 TRACE COLONY STE 2
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:601-992-3996
Practice Address - Fax:769-300-3112
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02756731Medicaid
MSF62643Medicare UPIN
MS080004235Medicare ID - Type Unspecified
MS080004233Medicare ID - Type Unspecified
MS080004237Medicare ID - Type Unspecified
MS080004231Medicare ID - Type Unspecified
MS080004236Medicare ID - Type Unspecified
MS02756731Medicaid
MS080004234Medicare ID - Type Unspecified
MS080004238Medicare ID - Type Unspecified
MS080004239Medicare ID - Type Unspecified
MS080004240Medicare ID - Type Unspecified