Provider Demographics
NPI:1487645420
Name:RICHARDS, DALLAS L (MD)
Entity type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 PARK ST.
Mailing Address - Street 2:LL045MU
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4009
Mailing Address - Country:US
Mailing Address - Phone:785-628-4678
Mailing Address - Fax:785-628-4089
Practice Address - Street 1:600 PARK ST.
Practice Address - Street 2:LL045MU
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4009
Practice Address - Country:US
Practice Address - Phone:785-628-4678
Practice Address - Fax:785-628-4089
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-16850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082500-AMedicaid
KS1059Medicare ID - Type Unspecified
KS100082500-AMedicaid