Provider Demographics
NPI:1760536221
Name:RICHARDSON, FRED III D (MD MSPH)
Entity Type:Individual
Prefix:DR
First Name:FRED III
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 FREEDOM PARK DR
Mailing Address - Street 2:
Mailing Address - City:N HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3449 FREEDOM PARK DR
Practice Address - Street 2:
Practice Address - City:N HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4607
Practice Address - Country:US
Practice Address - Phone:916-708-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC429742083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine