Provider Demographics
NPI:1710273552
Name:DAY RICHARDSON, COLBY LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:LAUREN
Last Name:DAY RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLBY
Other - Middle Name:LAUREN
Other - Last Name:STEGALL DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3050
Mailing Address - Fax:904-244-3028
Practice Address - Street 1:653-1 W 8TH ST # L-16
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3050
Practice Address - Fax:904-244-3050
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.33859 LL208000000X
FLME132191208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021180600Medicaid