Provider Demographics
NPI:1447622345
Name:RICHARDSON, DAVID PAUL JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:RICHARDSON
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2924 SISKIYOU BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6462
Mailing Address - Country:US
Mailing Address - Phone:541-200-2777
Mailing Address - Fax:541-214-2575
Practice Address - Street 1:2924 SISKIYOU BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6462
Practice Address - Country:US
Practice Address - Phone:541-200-2777
Practice Address - Fax:541-214-2575
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2022-10-13
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Provider Licenses
StateLicense IDTaxonomies
ORPA202759363A00000X
WAPA60606167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant