MEDICARE: JAMES D 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	207Q00000X	Family Medicine Physician	21821	WI

General Provider Information

NPI Number	:	1891785333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D RICHARDSON MD

Provider Business Mailing Address
First Line	:	520 AMY DR
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-9337
Country	:	US
Telephone Number	:	608-526-3351
Fax Number	:	608-526-3412

Provider Business Practice Location Address
First Line	:	520 AMY DR
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-9337
Country	:	US
Telephone Number	:	608-526-3351
Fax Number	:	608-526-3412

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	01/24/2012

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