Provider Demographics
NPI:1184689200
Name:WIRZ, RICHARD L JR (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:WIRZ
Suffix:JR
Gender:M
Credentials:DO
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 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:225 PHYSICIANS PARK STE 301
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3930
Practice Address - Country:US
Practice Address - Phone:573-686-2220
Practice Address - Fax:573-686-5642
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108936207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO435781OtherHEALTHLINK
MOP00177114OtherRAILROAD MEDICARE
MO681158OtherBCBS
MOP00177114OtherRAILROAD MEDICARE
MO108020001Medicare PIN
MO681158OtherBCBS