Healthcare Provider Details

I. General information

NPI: 1508144304
Provider Name (Legal Business Name): SEAN RICHARDSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701-5998
US

IV. Provider business mailing address

PO BOX 31326
FORT GREELY AK
99731-1326
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-2682
  • Fax: 907-458-2628
Mailing address:
  • Phone: 907-873-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number128530
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: