Provider Demographics
NPI:1710204862
Name:RICHARDSON, JEFF S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE C-115
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1764
Mailing Address - Country:US
Mailing Address - Phone:859-278-8855
Mailing Address - Fax:859-278-8856
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C-115
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1764
Practice Address - Country:US
Practice Address - Phone:859-278-8855
Practice Address - Fax:859-278-8856
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2017-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY00362213ES0103X
FLPO3837213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK002223OtherMEDICARE PTAN