Provider Demographics
NPI:1689659849
Name:RICHARDSON, WARREN STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:STEVEN
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 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4501
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4501
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00080924OtherRR MEDICARE NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
OR227108Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
ORR111965Medicare PIN