Provider Demographics
NPI:1508144304
Name:RICHARDSON, SEAN (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31326
Mailing Address - Street 2:
Mailing Address - City:FORT GREELY
Mailing Address - State:AK
Mailing Address - Zip Code:99731-1326
Mailing Address - Country:US
Mailing Address - Phone:907-873-4865
Mailing Address - Fax:
Practice Address - Street 1:655 5TH ST
Practice Address - Street 2:
Practice Address - City:FORT GREELY
Practice Address - State:AK
Practice Address - Zip Code:99731
Practice Address - Country:US
Practice Address - Phone:907-873-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine