Provider Demographics
NPI:1891780391
Name:RICHARDSON, ADAM A (DPM)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 THISTLE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5800
Mailing Address - Country:US
Mailing Address - Phone:512-394-5414
Mailing Address - Fax:
Practice Address - Street 1:13219 RESEARCH BLVD STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3231
Practice Address - Country:US
Practice Address - Phone:512-673-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI682213E00000X
TX1806213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39258Medicare UPIN