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General NPI Number Information
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NPI Number | 1831412311
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Entity Type | Individual
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Provider Name | LEON A RICHARDSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | TEXAS MEDCLINIC 8341 AGORA PKWAY
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City | SELMA
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State | TX
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Zip | 78154
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Country | US
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Telephone | 210-559-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 36000 DARNALL LOOP CARL R. DARNALL ARMY MEDICAL CENTER
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City | FORT HOOD
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State | TX
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Zip | 76544
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Country | US
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Telephone | 245-618-8781
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06662
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License Number State | TX
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