Provider Demographics
NPI:1780939868
Name:RICHARDSON, STEPHEN F (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
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 1:9493 S GRANITE FARM RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-2517
Mailing Address - Country:US
Mailing Address - Phone:801-541-1615
Mailing Address - Fax:
Practice Address - Street 1:9493 S GRANITE FARM RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-2517
Practice Address - Country:US
Practice Address - Phone:801-541-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165264-12051744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study