Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 57881 | MN |
NPI | 1477782738 |
---|---|
Provider Name | William Douglas Richards |
First Address | Alexandria, MN 56308-0057 |
Second Address | Alexandria, MN 56308-0057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FR2261523 | DEA (01) | MN |