Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036-044156 | IL |
NPI | 1033105093 |
---|---|
Provider Name | Dr. Robert R Richardson |
First Address | Winfield, IL 60190-1295 |
Second Address | Geneva, IL 60134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036044156 | (05) | IL |
C44940 | (02) | IL |