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General NPI Number Information
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NPI Number | 1700867215
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Entity Type | Individual
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Provider Name | DONALD RICHARDSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 12345 W BEND DR SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2182
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Country | US
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Telephone | 314-849-6000
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Fax | 314-849-1417
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Provider Business Mailing Address
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Address Line | PO BOX 23340
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City | SAINT LOUIS
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State | MO
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Zip | 63156-3340
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Country | US
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Telephone | 314-849-6000
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Fax | 314-849-1417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | R6979
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R6979
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License Number State | MO
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