Healthcare Provider Details

I. General information

NPI: 1396788873
Provider Name (Legal Business Name): ERIC J RICHARDSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 JERRY MURPHY RD STE 100
PUEBLO CO
81001-1256
US

IV. Provider business mailing address

2037 JERRY MURPHY RD STE 100
PUEBLO CO
81001-1256
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-5958
  • Fax: 719-544-5991
Mailing address:
  • Phone: 719-544-5958
  • Fax: 719-544-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number595
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number595
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: