Provider Demographics
NPI:1124018999
Name:RICHARDSON, PAUL EL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EL
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5735
Mailing Address - Country:US
Mailing Address - Phone:319-234-2649
Mailing Address - Fax:319-233-2430
Practice Address - Street 1:3410 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5735
Practice Address - Country:US
Practice Address - Phone:319-234-2649
Practice Address - Fax:319-233-2430
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35033208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421014941-22OtherJOHN DEERE
IA168627OtherCOVENTRY HMO
IAP00050800OtherRAILROAD MEDICARE
IA0289181Medicaid
IA34082OtherBCBS OF IOWA
IAP00050800OtherRAILROAD MEDICARE
IA421014941-22OtherJOHN DEERE