Individual
MR. RICHARD DYER MUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2205 S GALISTEO ST, SANTA FE, NM 87505
(505) 820-5899
Mailing address
455 SAINT MICHAELS DR, MEDICAL STAFF OFFICE, SANTA FE, NM 87505-7601
(505) 802-5227
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1348
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z0979
—
NM
01
—
1004541
LOVELACE HSC
—
01
—
14763
MOLINA HSC
—
01
—
NM01E22
BCBS NM
NM
Enumeration date
12/22/2006
Last updated
12/11/2007
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