Provider Demographics
NPI:1073573481
Name:MATTER, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MATTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 CORPORATE DR
Mailing Address - Street 2:STE. 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5416
Mailing Address - Country:US
Mailing Address - Phone:859-277-9436
Mailing Address - Fax:
Practice Address - Street 1:701 BOB O LINK DR
Practice Address - Street 2:STE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3759
Practice Address - Country:US
Practice Address - Phone:859-277-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010394002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64129463Medicaid
MI300F362430OtherBCBSM
MI1577948Medicaid
KYP00396831OtherRR MEDICARE
KY0663906Medicare PIN
KY00588003Medicare PIN
MI300F362430OtherBCBSM
MI1577948Medicaid
MIOF36243006Medicare PIN