Individual
RICHARD SO
Active
Individual
RICHARD SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
35090551
OH
208000000X
Pediatrics Physician
Primary
35090551
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000536776
ANTHEM BC/BS
OH
05
—
2780745
—
OH
01
—
340714618243
CARESOURCE
OH
Enumeration date
07/15/2006
Last updated
01/10/2009
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