MEDICARE: GEORGE B RICHERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	030866	CT
2	2084N0400X	Neurology Physician	39101	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164404802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE B RICHERSON MD

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1007
Country	:	US
Telephone Number	:	319-356-1616
Fax Number	:	319-384-7199

Provider Business Practice Location Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1007
Country	:	US
Telephone Number	:	319-356-1616
Fax Number	:	319-384-7199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/25/2010

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Directions to “ GEORGE B RICHERSON MD” Practice Location

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