Richard George Rougeau, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

2001002338 Issued in MO

Practice address

17679 Wildridge Drive
Wildwood, MO 63005

Phone

(636) 519-8626

NPI assigned

Apr 3, 2014

Last updated

Apr 3, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396483200000",
    "number": "1265850556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17679 WILDRIDGE DRIVE",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "63005",
            "telephone_number": "636-519-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17679 WILDRIDGE DRIVE",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "63005",
            "telephone_number": "636-519-8626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGEAU",
        "first_name": "RICHARD",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2001002338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Wildwood, MO
• Providers in Wildwood, MO by specialty
• General Practice Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.