Individual
KIRK JUSTIN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
(928) 214-2925
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(409) 772-1224
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
67220
AZ
207L00000X
Anesthesiology Physician
BP10063869
TX
Other
Enumeration date
04/17/2018
Last updated
10/03/2022
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