Provider Demographics
NPI:1508985417
Name:RICHARDSON, TIM ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:ALAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2626 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8110
Mailing Address - Country:US
Mailing Address - Phone:316-636-6100
Mailing Address - Fax:316-636-5813
Practice Address - Street 1:2626 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8110
Practice Address - Country:US
Practice Address - Phone:316-636-6100
Practice Address - Fax:316-636-5813
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35760208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology