Individual
DR. RANDOLPH MACON RICHARDSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
6120 WINKLER RD, STE F, FORT MYERS, FL 33919
(239) 437-1500
(239) 437-1560
Mailing address
PO BOX 07352, 6120 WINKLER RD STE F, FORT MYERS, FL 33919
(239) 437-1500
(239) 437-1560
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN0014165
FL
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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