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Individual

FRED RICHARDSON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
904 MEDICAL PARK DR, SUITE 3, EFFINGHAM, IL 62401-2193
(217) 540-2350
(217) 347-2323
Mailing address
904 MEDICAL PARK DR, SUITE 3, EFFINGHAM, IL 62401-2193
(217) 540-2350
(217) 347-2323

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036078174
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036078174
IL
Enumeration date
12/30/2005
Last updated
04/01/2021
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