Provider Demographics
NPI:1962451252
Name:RICHARDSON, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1616
Mailing Address - Street 2:P.O. BOX 11407
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1616
Mailing Address - Country:US
Mailing Address - Phone:901-682-6828
Mailing Address - Fax:
Practice Address - Street 1:3000 GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2205
Practice Address - Country:US
Practice Address - Phone:901-369-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021808207P00000X
TNMD21808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121388OtherMS MEDICAID
TN3861105Medicaid
TN4046868OtherBLUE CROSS
AR140193001Medicaid
421659814OtherTRICARE
TNF44066OtherHEALTHSPRINGS
TN3861105Medicaid
TN3729623Medicare PIN