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WILL RICHARDSON MD PA NPI 1508952458


NPI Information

NPI: 1508952458
Provider Name: WILL RICHARDSON MD PA

Doing Business As: NATURA DERMATOLOGY & COSMETICS

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 10D1065839

Address:
1120 BAYVIEW DR
FORT LAUDERDALE, FL
ZIP 33304
Phone: (954) 537-4106
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WILL RICHARDSON MD PA is a medical specialty clinic center in Fort Lauderdale, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). WILL RICHARDSON MD PA NPI is 1508952458. The provider is registered as an organization entity type.
The provider Is Doing Business As Natura Dermatology & Cosmetics.

The provider's business location address is:

1120 BAYVIEW DR
FORT LAUDERDALE, FL
ZIP 33304-505
Phone: (954) 537-4106
Fax: (954) 537-4186

The provider's authorized official is Willie Forrest Richardson .
The authorized official title is Sole Proprietor and has the following contact phone number (954) 537-4106.

The CLIA number assigned to this NPI record is 10D1065839 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/5/2006 and was last updated on 11/4/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM2500XClinic/CenterMedical SpecialtyME94167FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
130022ZMEDICARE ID-TYPE UNSPECIFIEDFLORIDAMEDICARE
2I02128MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.