Individual
DR. BLAKELY S RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2559 WESTERN TRAILS BLVD, SUITE 301, AUSTIN, TX 78745-1565
(512) 815-2559
Mailing address
2559 WESTERN TRAILS BLVD, STE 301, AUSTIN, TX 78745-1565
(512) 815-2559
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
P7024
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P7024
TEXAS STATE LICENSE
TX
Enumeration date
04/19/2010
Last updated
09/08/2016
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