Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5177 | CO |
NPI | 1194909119 |
---|---|
Provider Name | Dr. Damian Seth Richardson |
First Address | Creede, CO 81130-0123 |
Second Address | Creede, CO 81130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 27/12/2007 |