Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2136640 | TX |
NPI | 1003438540 |
---|---|
Provider Name | Nichlos Arlen Richardson |
First Address | Howe, TX 75459-3698 |
Second Address | Howe, TX 75459-3698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2020 |
Last Update Date | 06/05/2020 |