Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 47711 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 47711 | AZ |
NPI | 1053499541 |
---|---|
Provider Name | Todd A. Richards |
First Address | Phoenix, AZ 85011-7587 |
Second Address | Phoenix, AZ 85004-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 07/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
810077 | (05) | AZ |
I47395 | (02) |