Healthcare Provider Details

I. General information

NPI: 1891780391
Provider Name (Legal Business Name): ADAM A RICHARDSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13219 RESEARCH BLVD STE E
AUSTIN TX
78750-3231
US

IV. Provider business mailing address

6846 THISTLE HILL WAY
AUSTIN TX
78754-5800
US

V. Phone/Fax

Practice location:
  • Phone: 512-673-6640
  • Fax:
Mailing address:
  • Phone: 512-394-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number682
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: