Provider Demographics
NPI:1134239437
Name:RICHARDSON, MARION L III (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:L
Last Name:RICHARDSON
Suffix:III
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 1:1555 INDIAN RIVER BLVD
Mailing Address - Street 2:B120
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7103
Mailing Address - Country:US
Mailing Address - Phone:772-778-9621
Mailing Address - Fax:
Practice Address - Street 1:1555 INDIAN RIVER BLVD STE B120
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7108
Practice Address - Country:US
Practice Address - Phone:772-778-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42769207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology