Provider Demographics
NPI:1811513641
Name:RICHARDSON, BETH BARBARA (DPM)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:BARBARA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:BARBARA
Other - Last Name:REITTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1253 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2201
Mailing Address - Country:US
Mailing Address - Phone:779-696-9201
Mailing Address - Fax:815-397-9645
Practice Address - Street 1:1253 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2201
Practice Address - Country:US
Practice Address - Phone:779-696-9201
Practice Address - Fax:815-397-9645
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005964213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery