Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | E5742 | AR |
N | 208200000X | Surgeon | 35.088306 | OH |
N | 208600000X | Surgeon | 35.088306 | OH |
NPI | 1093858581 |
---|---|
Provider Name | Dr. Gresham T Richter |
First Address | Little Rock, AR 72202-3510 |
Second Address | Little Rock, AR 72202-3510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 10/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
172425001 | (05) | AR |