Individual
DR. SHANE BYRN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Mailing address
1105 101ST AVE W, DULUTH, MN 55808-1804
(612) 251-8798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64730
MN
207Q00000X
Family Medicine Physician
R73957
AZ
Other
Enumeration date
06/15/2013
Last updated
01/29/2019
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