Provider Demographics
NPI:1114988193
Name:HULL, RICHARD L (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:HULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:LEE
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0764
Mailing Address - Country:US
Mailing Address - Phone:620-365-6933
Mailing Address - Fax:620-365-8126
Practice Address - Street 1:401 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3256
Practice Address - Country:US
Practice Address - Phone:620-365-6933
Practice Address - Fax:620-365-8126
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-16908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098320 BMedicaid
C60012Medicare UPIN
KS100098320 BMedicaid