Basic Information
| Provider Information | |||||||||
| NPI: | 1932532686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JASON P RICHARDS MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 HOSPITAL WAY STE 477 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082338344 | ||||||||
| FaxNumber: | 2082336983 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 HOSPITAL WAY STE 477 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082338344 | ||||||||
| FaxNumber: | 2082336983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDS | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2082338344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | M12138 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.