Individual
DR. BENJAMIN RUSSELL RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5171 CUB LAKE RD STE B210, SHOW LOW, AZ 85901-7866
(928) 537-0635
(928) 532-8957
Mailing address
5171 CUB LAKE RD STE 210, SHOW LOW, AZ 85901-7888
(928) 537-0635
(928) 532-8957
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
006656
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022296
—
AZ
Enumeration date
06/09/2011
Last updated
03/08/2017
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