Individual
DONALD RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12345 W BEND DR, SUITE 300, SAINT LOUIS, MO 63128-2182
(314) 849-6000
(314) 849-1417
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 849-6000
(314) 849-1417
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
R6979
MO
207R00000X
Internal Medicine Physician
Primary
R6979
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010031
ESSENCE
MO
01
—
0400272
UHC
MO
01
—
114793
HEALTHLINK
MO
01
—
127486
GHP
MO
05
—
201659414
—
MO
01
—
4214916
AETNA
MO
01
—
9184
BCBS
MO
01
—
A10039
MERCY
MO
Enumeration date
11/10/2005
Last updated
09/28/2012
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