Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 19452 | AL |
NPI | 1023091436 |
---|---|
Provider Name | Mr. Larry Braden Richmond JR. |
First Address | Anniston, AL 36207-5761 |
Second Address | Anniston, AL 36207-5761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 21/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051503068 | (05) | AL |
51503068 | BCBS (01) | AL |
G25399 | (02) |