Provider Demographics
NPI:1790847978
Name:RICHARDSON, NATHAN DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVIS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3010 W AGUA FRIA FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3943
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:3420 S MERCY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0419
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42715207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830007OtherMEDICARE NSC DV
AZ5550830011OtherMEDICARE NSC CENTRAL PHOENIX
AZ5550830012OtherMEDICARE NSC SPINE CENTER
AZ5550830003OtherMEDICARE NSC PEORIA
AZ521790Medicaid
AZ5550830010OtherMEDICARE NSC GILBERT
AZ521790Medicaid