Healthcare Provider Details

I. General information

NPI: 1568454171
Provider Name (Legal Business Name): JEFFREY R RICHARDSON M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 MARKET ST STE 410
VENTURA CA
93003-7780
US

IV. Provider business mailing address

4482 MARKET ST STE 410
VENTURA CA
93003-7780
US

V. Phone/Fax

Practice location:
  • Phone: 805-535-4422
  • Fax: 805-648-4426
Mailing address:
  • Phone: 805-535-4422
  • Fax: 805-648-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG38557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: