1649231424 NPI number — WILLIAM WEBB RICHARDSON D.O.

Table of content: WILLIAM WEBB RICHARDSON D.O. (NPI 1649231424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649231424 NPI number — WILLIAM WEBB RICHARDSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
WILLIAM
Provider Middle Name:
WEBB
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649231424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33970-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-369-4088
Provider Business Mailing Address Fax Number:
239-369-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 LEE BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33936-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-369-4088
Provider Business Practice Location Address Fax Number:
239-369-0588
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  OS4428 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 374798100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82480C . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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