Provider Demographics
NPI:1790869642
Name:KYLE, RICHARD SLATER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SLATER
Last Name:KYLE
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 1:1502 SE 28TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3988
Mailing Address - Country:US
Mailing Address - Phone:479-273-1220
Mailing Address - Fax:
Practice Address - Street 1:1502 SE 28TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3988
Practice Address - Country:US
Practice Address - Phone:479-273-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8005207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF75118Medicare UPIN
AR5J329Medicare ID - Type Unspecified