MEDICARE: JUSTIN RICHARDSON DO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1952939647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN RICHARDSON DO

Provider Business Mailing Address
First Line	:	713 E ANDERSON ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 8TH AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3902
Country	:	US
Telephone Number	:	817-336-2100
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	10/26/2023

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Directions to “ JUSTIN RICHARDSON DO” Practice Location

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