Provider Demographics
NPI:1275594087
Name:PRICE, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:175-564-7624
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:760-520-8523
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR459512085R0202X
FLME1305412085R0202X
OK259492085R0202X
TXN03822085R0202X
CAG539552085R0202X, 2085R0204X
ARE-90772085R0202X
KS04327492085R0202X
AZ374202085R0202X
IN01061014A2085R0202X
MN503182085R0202X
ND109872085R0202X
WI23845-202085R0202X
MO20070236232085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G539550Medicaid
MO204611800Medicaid
CAWG53955CMedicare PIN
CA00G539550Medicaid
CAWG53955GMedicare PIN
CAWG53955BMedicare PIN
CAWG53955AMedicare PIN
300015638Medicare PIN
CAWG53955IMedicare PIN