Provider Demographics
NPI:1487665105
Name:RICHARDS, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:RICHARDS
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 1:1118 ROSS CLARK CIRCLE SE
Mailing Address - Street 2:DOCTOR'S BUILDING SUITE 600
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3007
Mailing Address - Country:US
Mailing Address - Phone:334-793-3900
Mailing Address - Fax:334-793-5227
Practice Address - Street 1:1118 ROSS CLARK CIRCLE SE
Practice Address - Street 2:DOCTOR'S BUILDING SUITE 600
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3007
Practice Address - Country:US
Practice Address - Phone:334-793-3900
Practice Address - Fax:334-793-5227
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27711207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940108Medicaid
AL009939831Medicaid
AL51537214OtherBCBS ALABAMA
AL51537843OtherBCBS ALABAMA
AL51537214Medicare ID - Type UnspecifiedMEDICARE
AL51537214Medicare ID - Type Unspecified
AL009940108Medicaid