Provider Demographics
NPI:1023037967
Name:RICHARDSON, WALTER P (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:P
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7210
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0210
Mailing Address - Country:US
Mailing Address - Phone:913-338-4070
Mailing Address - Fax:913-338-4245
Practice Address - Street 1:7800 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2304
Practice Address - Country:US
Practice Address - Phone:913-338-4070
Practice Address - Fax:913-338-4245
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18460207ZP0102X
MO118456207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58799Medicare UPIN