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General NPI Number Information
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NPI Number | 1811948524
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Entity Type | Organization
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Legal Business Name | JEFFREY B. RICHARDSON, M.D., P.S.C.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 2333 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9162
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Country | US
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Telephone | 270-737-4503
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Fax | 270-769-1978
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Provider Business Mailing Address
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Address Line | 2333 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9162
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Country | US
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Telephone | 270-737-4503
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Fax | 270-769-1978
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY B. RICHARDSON
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Credential | MD
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Telephone | 270-737-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25905
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License Number State | KY
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