Healthcare Provider Details

I. General information

NPI: 1366521908
Provider Name (Legal Business Name): MADISON F RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD SUITE 908
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

8500 WILSHIRE BLVD SUITE 908
BEVERLY HILLS CA
90211-3121
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-9520
  • Fax: 310-360-9526
Mailing address:
  • Phone: 310-360-9520
  • Fax: 310-360-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG18826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: