Richard Austin Haddock IV, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD08569 Issued in OR

Practice address

503 4TH St
La Grande, OR 97850-1905

Phone

(541) 963-2886

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689610834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501905",
            "telephone_number": "541-963-2886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501905",
            "telephone_number": "541-963-2886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDOCK",
        "first_name": "RICHARD",
        "middle_name": "AUSTIN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD08569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R-083501",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clark Joseph Grover, DMD
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• Barbara Ann Guentert
• Micajah Kody Guentert
• Mihali Gunasekara
• Joanna Hallam, PT, DPT
• William E Halstead, MD
• Rochelle Diane Hamilton
• Travis Theron Hampton, DPM
• Juliann Hanson, OTR

• Surgery Physician in La Grande, OR
• Providers in La Grande, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.