Individual
TIMOTHY JACE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Mailing address
25 BRYANT ST, WARD, AR 72176-8520
(501) 658-9717
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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