Provider Demographics
NPI:1659315182
Name:RICHARDS, KENT FARNSWORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:FARNSWORTH
Last Name:RICHARDS
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-7660
Mailing Address - Fax:
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:#224
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1577291205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057029Medicaid
UT942854057029Medicaid
UT000001485Medicare PIN
UT005773602Medicare PIN
UT000063169Medicare PIN
UT000062334Medicare PIN
UT006994002Medicare PIN
UT000061382Medicare PIN