Provider Demographics
NPI:1477782738
Name:RICHARDS, WILLIAM DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 17TH AVE E STE 1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-0057
Mailing Address - Country:US
Mailing Address - Phone:320-759-4326
Mailing Address - Fax:320-759-4327
Practice Address - Street 1:111 17TH AVE E STE 1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-0057
Practice Address - Country:US
Practice Address - Phone:320-759-4326
Practice Address - Fax:320-759-4327
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57881207YX0905X
PAOS015330207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNFR2261523OtherDEA