Provider Demographics
NPI:1184689101
Name:DANNENBERG, RICHARD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:DANNENBERG
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:UNIVERSITY OF KENTUCKY
Mailing Address - Street 2:740 S. LIMESTONE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5867
Mailing Address - Fax:859-323-4781
Practice Address - Street 1:UNIVERSITY OF KENTUCKY
Practice Address - Street 2:740 S. LIMESTONE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5867
Practice Address - Fax:859-323-4781
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27830207W00000X
KY20875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110565OtherEYEMED
MN114683OtherU-CARE
MNPREFERRED ONEOther826041022794
MNBCBSMOther43034DA
MNHEALTH PARTNERSOther19379
MNMEDICAOther0808759
MN475067500Medicaid
MN110565OtherEYEMED
MNBCBSMOther43034DA
MN475067500Medicaid
MN110565OtherEYEMED