Provider Demographics
NPI:1023091436
Name:RICHMOND, LARRY BRADEN JR (MD)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:BRADEN
Last Name:RICHMOND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:731 LEIGHTON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5761
Mailing Address - Country:US
Mailing Address - Phone:256-435-2229
Mailing Address - Fax:256-782-2904
Practice Address - Street 1:731 LEIGHTON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5761
Practice Address - Country:US
Practice Address - Phone:256-435-2229
Practice Address - Fax:256-782-2904
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19452207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503068Medicaid
AL51503068OtherBCBS
G25399Medicare UPIN
AL051503068Medicare ID - Type Unspecified