Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11014423A | IN |
N | 207X00000X | Orthopaedic Surgeon | 48932 | AZ |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 48932 | AZ |
NPI | 1134389232 |
---|---|
Provider Name | Wilford Lee Richardson |
First Address | Prescott, AZ 86301-1427 |
Second Address | Prescott, AZ 86301-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 05/08/2014 |