Randolph Macon Richardson IV, DMD MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DN0014165 Issued in FL

Practice address

6120 Winkler Rd
Ste F
Fort Myers, FL 33919

Phone

(239) 437-1500

Fax

(239) 437-1560

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609803881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 07352",
            "address_2": "6120 WINKLER RD STE F",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33919",
            "telephone_number": "239-437-1500",
            "fax_number": "239-437-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 WINKLER RD",
            "address_2": "STE F",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33919",
            "telephone_number": "239-437-1500",
            "fax_number": "239-437-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "RANDOLPH",
        "middle_name": "MACON",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DMD  MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "DN0014165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• P Jeffrey Richards, MD
• Whitney Amber Richards, DDS
• Colby Allen Richardson, M.D.
• Nicole L Richardson
• Owen S. Richardson, M.D.
• Sabrina Richardson, M.S.W, CBHCMS
• Jessie Richeme
• Jolie Alexis Richman
• Kitiara Richmond
• Raven Dawn Richmond

• Oral & Maxillofacial Surgery (D.M.D.) in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.