# WILL RICHARDSON MD PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WILL RICHARDSON, M.D.
- **Other names:** Natura Dermatology & Cosmetics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1508952458
- **Legal business name:** WILL RICHARDSON, M.D.
- **Authorized official:** DR. WILLIE FORREST RICHARDSON JR. MD (SOLE PROPRIETOR)
- **Authorized official phone:** (954) 537-4106

## Contact information

- **Practice address:** 1120 BAYVIEW DR, FORT LAUDERDALE, FL 33304-2505
- **Practice address phone:** (954) 537-4106
- **Practice address fax:** (954) 537-4186
- **Mailing address:** 1120 BAYVIEW DR, FORT LAUDERDALE, FL 33304-2505
- **Mailing address phone:** (954) 537-4106
- **Mailing address fax:** (954) 537-4186

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | ME94167 | FL | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 11/04/2009