MEDICARE: DR. PAUL TIMOTHY 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	2084P0800X	Psychiatry Physician	35810	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125T1RI	OTHER	MN	BCBS OF MN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1555718	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1750369088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL TIMOTHY RICHARDSON MD

Provider Business Mailing Address
First Line	:	3727 FAIRWAY POINT
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125
Country	:	US
Telephone Number	:	651-702-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	STE 229N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-645-3115
Fax Number	:	651-645-2752

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	11/24/2008

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