MEDICARE: NATHAN DAVIS RICHARDSON M.D.

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	207X00000X	Orthopaedic Surgery Physician	42715	AZ
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	42715	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5550830001	OTHER	AZ	MEDICARE NSC SCW
2	5550830007	OTHER	AZ	MEDICARE NSC DV
3	5550830011	OTHER	AZ	MEDICARE NSC CENTRAL PHOENIX
4	5550830012	OTHER	AZ	MEDICARE NSC SPINE CENTER
5	5550830003	OTHER	AZ	MEDICARE NSC PEORIA
7	5550830010	OTHER	AZ	MEDICARE NSC GILBERT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790847978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN DAVIS RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	3010 W AGUA FRIA FWY
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3943
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

Provider Business Practice Location Address
First Line	:	3420 S MERCY RD
Second Line	:	SUITE 200
City	:	GILBERT
State	:	AZ
Zip	:	85297-0419
Country	:	US
Telephone Number	:	623-537-5600
Fax Number	:	866-939-2673

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	05/18/2012

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