Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 310 | NC |
NPI | 1104083427 |
---|---|
Provider Name | Dr. Reginald Barnette Richardson JR. |
First Address | Charlotte, NC 28266-8093 |
Second Address | Charlotte, NC 28208-5631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 09/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U20739 | (02) | NC |