Individual
BRECK T RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
332 HWY 12 WEST, KOSCIUSKO, MS 39090
(662) 289-1800
(662) 289-2486
Mailing address
PO BOX 23996, JACKSON, MS 39225
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21932
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09723710
—
MS
Enumeration date
04/08/2009
Last updated
12/11/2012
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