Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 206009605 | MO |
NPI | 1003874181 |
---|---|
Provider Name | Dr. Matthew B Richins |
First Address | Joplin, MO 64803-3592 |
Second Address | Joplin, MO 64804-1542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200422090B | (05) | KS |
212522 | BCBS (01) | MO |
301595708 | (05) | MO |
626280200 | MEDICAID DME (01) | MO |
V09098 | (02) | MO |