Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 595 | CO |
N | 222Z00000X | Podiatrist | 595 | CO |
Y | 213ES0131X | Foot Surgery | 595 | CO |
NPI | 1396788873 |
---|---|
Provider Name | Eric J Richardson |
First Address | Pueblo, CO 81001-1256 |
Second Address | Pueblo, CO 81001-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U77272 | (02) | CO |