MEDICARE: STEVEN G RICHARDSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11809415-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0104083	OTHER	OH	UHC
2	P00013823	OTHER	OH	RRM
3	000000286657	OTHER	OH	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	141867207026	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1629030838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN G RICHARDSON MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	801-316-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 E SEGO LILY DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4350
Country	:	US
Telephone Number	:	801-316-9620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	06/18/2021

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