Individual
DR. JASON P RICHARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201
(208) 233-8344
(208) 233-6983
Mailing address
393 E WALNUT ST, PHR GROUP PROVIDER ENROLLMENT UNIT, 3RD FL, PASADENA, CA 91188-0001
(626) 405-7914
(626) 405-4600
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A120201
CA
Other
Enumeration date
01/09/2008
Last updated
12/06/2021
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