Individual
SAMUEL RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 N. TENAYA WAY, GRADUATE MEDICAL EDUCATION, LAS VEGAS, NV 89128-0431
(702) 962-9551
Mailing address
3100 N. TENAYA WAY, GRADUATE MEDICAL EDUCATION, LAS VEGAS, NV 89128-0431
(702) 962-9551
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
010323
AZ
207P00000X
Emergency Medicine Physician
Primary
DO3495
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D06098084
STATE ISSUED DRIVER'S LICENSE
AZ
Enumeration date
03/30/2020
Last updated
04/24/2024
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