Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 5071 | AZ |
Y | 111NR0400X | Rehabilitation Chiropractor | 5071 | AZ |
NPI | 1205059680 |
---|---|
Provider Name | Dr. Bruce C Richardson |
First Address | Anthem, AZ 85086-0430 |
Second Address | Peoria, AZ 85381-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 07/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U52468 | (02) | AZ |