Provider Demographics
NPI:1699840769
Name:RICHARDSON, REBECCA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JEAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 SE NEWPORT WAY
Mailing Address - Street 2:#F-129
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9036
Mailing Address - Country:US
Mailing Address - Phone:206-817-0289
Mailing Address - Fax:
Practice Address - Street 1:18501 SE NEWPORT WAY
Practice Address - Street 2:#F-129
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-9036
Practice Address - Country:US
Practice Address - Phone:206-817-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8808983Medicare PIN
WAI21338Medicare UPIN