Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | Q9496 | TX |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | Q9496 | TX |
NPI | 1457662702 |
---|---|
Provider Name | Dr. Matthew Allen Richardson |
First Address | Frisco, TX 75034-5805 |
Second Address | Frisco, TX 75034-5805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3736621 | (05) | TX |
T2354 | MEDICAL LICENSE (01) | MS |