Provider Demographics
NPI:1245230788
Name:DOBYNS, RICHARD KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:DOBYNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:KEITH
Other - Last Name:DOBYNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:795 SIM HODGIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1928
Mailing Address - Country:US
Mailing Address - Phone:765-566-5949
Mailing Address - Fax:765-962-6268
Practice Address - Street 1:2030 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1215
Practice Address - Country:US
Practice Address - Phone:765-966-3100
Practice Address - Fax:765-966-3131
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001426A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100367870Medicaid
INP00689415OtherMEDICARE RAIL ROAD
D36064Medicare UPIN
INP00689415OtherMEDICARE RAIL ROAD
IN100367870Medicaid