Healthcare Provider Details

I. General information

NPI: 1508276288
Provider Name (Legal Business Name): JOHN ALBERT RICHARDS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR
ALTON IL
62002-6755
US

IV. Provider business mailing address

1 MEMORIAL DR
ALTON IL
62002-6755
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-7240
  • Fax: 618-463-7216
Mailing address:
  • Phone: 618-463-7240
  • Fax: 618-463-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036147892
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-147892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: