Individual
DR. CORY GLEN RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3318 N GRANDMILL LN, COEUR D ALENE, ID 83814-5689
(208) 292-0445
(208) 772-6514
Mailing address
3318 N GRANDMILL LN, COEUR D ALENE, ID 83814-5689
(208) 292-0445
(208) 772-6514
Taxonomy
Speciality
Code
Description
License number
State
207RB0002X
Obesity Medicine (Internal Medicine) Physician
M-13357
ID
207RG0100X
Gastroenterology Physician
M-13357
ID
208600000X
Surgery Physician
Primary
M-13357
ID
2086S0127X
Trauma Surgery Physician
M-13357
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295050342
—
ID
Enumeration date
04/01/2010
Last updated
10/07/2025
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