Healthcare Provider Details

I. General information

NPI: 1811139017
Provider Name (Legal Business Name): PODIATRY OFFICES OF DR. MILTON RICHARDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W WILLIAMS ST STE 105
APEX NC
27502-3955
US

IV. Provider business mailing address

1031 W WILLIAMS ST STE 105
APEX NC
27502-3955
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-3310
  • Fax: 919-363-3370
Mailing address:
  • Phone: 919-363-3310
  • Fax: 919-363-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number308
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0814N
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 2
Identifier10920106
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 3
Identifier26929
Identifier TypeOTHER
Identifier State
Identifier IssuerWELLPATH
# 4
Identifier5333086
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 5
Identifier890814N
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 6
Identifier2752571
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED
# 7
Identifier81278
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDCOST

VIII. Authorized Official

Name: DR. MILTON W. RICHARDSON
Title or Position: OWNER
Credential: DPM
Phone: 919-363-3310