Provider Demographics
NPI:1942201678
Name:RICHARDSON, LESTER E (DO)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:E
Last Name:RICHARDSON
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:PO BOX 411039
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1039
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21420207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100231530CMedicaid
KS100231530AMedicaid
KS12598099OtherBCBS OF KC MO
MO246039101Medicaid
01674018OtherBCBS KC MO GROUP 0167401
MO12598119OtherBCBS OF KC MO
930036542OtherRR MEDICARE GROUP CG8899
P00215045OtherRR MEDICARE GROUP DC6712
KSB51130Medicare UPIN
01674018OtherBCBS KC MO GROUP 0167401
KSR975809Medicare PIN