Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 11076 | MS |
NPI | 1013951987 |
---|---|
Provider Name | Randy K Richardson |
First Address | Oxford, MS 38655-5302 |
Second Address | Oxford, MS 38655-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0123194 | (05) | MS |
D88109 | (02) | MS |