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General NPI Number Information
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NPI Number | 1942564315
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Entity Type | Individual
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Provider Name | SPENCER DANIEL RICHARDSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 57 RATLIFF ST
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City | LUCEDALE
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State | MS
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Zip | 39452-5731
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Country | US
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Telephone | 601-766-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 105 DRINKWATER BLVD DEPARTMENT OF SURGERY
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City | BAY ST LOUIS
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State | MS
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Zip | 39520
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Country | US
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Telephone | 228-467-5983
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24758
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License Number State | MS
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