Provider Demographics
NPI:1588675953
Name:DAILEY, RICHARD R (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:DAILEY
Suffix:
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 1:408 E 7TH, PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724
Mailing Address - Country:US
Mailing Address - Phone:660-476-2121
Mailing Address - Fax:
Practice Address - Street 1:408 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1617
Practice Address - Country:US
Practice Address - Phone:660-476-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC50558Medicare UPIN