Provider Demographics
NPI:1649231424
Name:RICHARDSON, WILLIAM WEBB (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WEBB
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 220
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-0220
Mailing Address - Country:US
Mailing Address - Phone:239-369-4088
Mailing Address - Fax:239-369-0588
Practice Address - Street 1:391 LEE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4973
Practice Address - Country:US
Practice Address - Phone:239-369-4088
Practice Address - Fax:239-369-0588
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4428207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374798100Medicaid
FL82480COtherMEDICARE PTAN
FL374798100Medicaid