Healthcare Provider Details

I. General information

NPI: 1457511362
Provider Name (Legal Business Name): JONATHAN MARK RICHARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE. 701
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE. 701
BATON ROUGE LA
70808-4300
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5864
  • Fax: 225-765-2013
Mailing address:
  • Phone: 225-765-5864
  • Fax: 225-765-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD.204090
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD.204090
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: