Individual
BILLY DOOGAN RICHARDSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1122 N TOPEKA ST, WICHITA, KS 67214-2810
(316) 866-2000
(316) 866-2084
Mailing address
1122 N TOPEKA ST, WICHITA, KS 67214-2810
(316) 866-2000
(316) 866-2084
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-22073
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002106
MEDICARE PTAN
KS
05
—
100121830E
—
KS
01
—
P00912310
RR MEDICARE - PTAN
KS
Enumeration date
08/30/2006
Last updated
09/01/2023
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