Basic Information
| Provider Information | |||||||||
| NPI: | 1427085042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VETTER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013645751 | ||||||||
| FaxNumber: | 7013645750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/24/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5800 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 33414 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0112632 | 01 | ND | MEDICA # | OTHER | 16246 | 05 | ND | MEDICAID | 3M183VE | 01 | ND | MNBS # | OTHER | ND100034 | 01 | ND | LHS # | OTHER | 2M009VE | 01 | MN | MNBS # | OTHER | DA9011015649 | 01 | ND | PREFERRED ONE # | OTHER | 676662 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 0105985 | 01 | ND | MEDICA # | OTHER | 0C304VE | 01 | ND | MNBS # | OTHER | 55A99VE | 01 | ND | MNBS # | OTHER | HP19558 | 01 | ND | HEALTHPARTNERS # | OTHER | 251398600 | 05 | ND | MEDICAID | 0108145 | 01 | ND | MEDICA # | OTHER | 0C305VE | 01 | ND | MNBS # | OTHER | 111861 | 01 | ND | UCARE # | OTHER |