Provider Demographics
NPI:1851585772
Name:JEFFREY R. RICHARDSON M D
Entity Type:Organization
Organization Name:JEFFREY R. RICHARDSON M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:805-648-4425
Mailing Address - Street 1:2660 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2893
Mailing Address - Country:US
Mailing Address - Phone:805-648-4425
Mailing Address - Fax:805-648-4426
Practice Address - Street 1:2660 E MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2893
Practice Address - Country:US
Practice Address - Phone:805-648-4425
Practice Address - Fax:805-648-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38557207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG038557OtherLIC#
CAW14433Medicare PIN
CAA47515Medicare UPIN