Individual
PETER RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
719 W CENTENNIAL, CARTHAGE, MO 64836
(417) 358-1002
(417) 358-8660
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 358-1002
(417) 358-8660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R8689
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8980
ANTHEM
MO
Enumeration date
07/05/2006
Last updated
10/18/2007
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