Provider Demographics
NPI:1477502631
Name:BURCH, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BURCH
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 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:3301 S PROVIDENCE RD
Practice Address - Street 2:BLDG E
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3624
Practice Address - Country:US
Practice Address - Phone:573-882-2511
Practice Address - Fax:573-884-4515
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1083102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1583207OtherUNITED HEALTHCARE
MO2086826501OtherKANSAS MEDICAID
MO415917OtherHEALTHLINK
MO118801OtherBLUE CHOICE
MO118801OtherBLUE SHIELD
MO118801OtherBLUE SHIELD