Provider Demographics
NPI:1447241112
Name:RICHARDSON, CLIF S (DPM)
Entity Type:Individual
Prefix:
First Name:CLIF
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 YMCA PLAZA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0916
Mailing Address - Country:US
Mailing Address - Phone:225-763-7770
Mailing Address - Fax:
Practice Address - Street 1:8160 YMCA PLAZA DR
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0916
Practice Address - Country:US
Practice Address - Phone:225-763-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD317R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369691Medicaid
LA1369691Medicaid
LA5CH12Medicare ID - Type Unspecified