Individual
TYRUN KEITH RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1965 S FREMONT AVE, STE 370, SPRINGFIELD, MO 65804-2201
(417) 820-0300
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
04-33531
KS
208800000X
Urology Physician
Primary
2016012292
MO
208800000X
Urology Physician
31026
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200456750H
—
OK
05
—
200566690A
—
OK
05
—
200615150A
—
KS
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
07/14/2005
Last updated
06/16/2016
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