Provider Demographics
NPI:1811948524
Name:JEFFREY B. RICHARDSON, M.D., P.S.C.
Entity type:Organization
Organization Name:JEFFREY B. RICHARDSON, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-737-4503
Mailing Address - Street 1:2333 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9162
Mailing Address - Country:US
Mailing Address - Phone:270-737-4503
Mailing Address - Fax:270-769-1978
Practice Address - Street 1:2333 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9162
Practice Address - Country:US
Practice Address - Phone:270-737-4503
Practice Address - Fax:270-769-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25905207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF9123OtherRAILROAD MEDICARE GROUP