MEDICARE: BRUCE WILES RICHARDSON 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	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	25475	MN
2	207Q00000X	Family Medicine Physician	25475	MN

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	:	1699736066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE WILES RICHARDSON MD

Provider Business Mailing Address
First Line	:	1185 TOWN CENTRE DR STE 220
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1186
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:	651-379-1650

Provider Business Practice Location Address
First Line	:	1185 TOWN CENTRE DR STE 220
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-1186
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:	651-379-1650

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/05/2026

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Directions to “ BRUCE WILES RICHARDSON MD” Practice Location

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