Provider Demographics
NPI:1679550081
Name:GRIES, RICHARD L (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GRIES
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-0370
Mailing Address - Country:US
Mailing Address - Phone:812-464-3016
Mailing Address - Fax:812-753-4148
Practice Address - Street 1:304 E HWY 68
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639
Practice Address - Country:US
Practice Address - Phone:812-464-3016
Practice Address - Fax:812-753-4148
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024530A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04367929417OtherDONLEY & CO.
080192018OtherRAILROAD MEDICARE
065639OtherHEALTH ALLIANCE
616751OtherHEALTHLINK
043679294004OtherUNICARE
IN000000245599OtherBCBS
IN194750AMedicare PIN
IN000000245599OtherBCBS