Healthcare Provider Details

I. General information

NPI: 1700539905
Provider Name (Legal Business Name): WESTON TYLER RICHARDSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5461
  • Fax: 520-324-1406
Mailing address:
  • Phone: 520-327-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8944
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: