Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 49823 | TN |
N | 207V00000X | Obstetrician & Gynecologist | C160063 | CA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 49823 | TN |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | C160063 | CA |
NPI | 1154305977 |
---|---|
Provider Name | Alvie C. Richardson |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7057520 | (05) | RI |
I26999 | (02) | RI |