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NPI Code Detail

MEDICARE: ROBERT E RICHARDSON MD PROFESSIONAL CORP.

MEDICARE: ROBERT E RICHARDSON MD PROFESSIONAL CORP.
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
1208600000XSurgery PhysicianC23280CA

General Provider Information

NPI Number : 1427351162
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT E RICHARDSON MD PROFESSIONAL CORP.
Provider Business Mailing Address
First Line : 1812 HAPPY VALLEY ROAD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409
Country : US
Telephone Number : 707-545-2436
Fax Number : 707-545-8109
Provider Business Practice Location Address
First Line : 1812 HAPPY VALLEY ROAD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409
Country : US
Telephone Number : 707-545-2436
Fax Number : 707-545-8109
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT E RICHARDSON
Credential : MD
Telephone Number : 707-545-2436
Provider Enumeration Date : 12/20/2010
Last Update Date : 12/20/2010

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