Individual
OWEN S. RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13681 DOCTORS WAY STE 140, FORT MYERS, FL 33912-4300
(239) 343-0434
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-1403
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME169035
FL
2086S0102X
Surgical Critical Care Physician
ME169035
FL
2086S0127X
Trauma Surgery Physician
Primary
ME169035
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122875100
—
FL
Enumeration date
08/19/2013
Last updated
10/02/2024
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