Provider Demographics
NPI:1912084344
Name:KINGSTON, RICHARD ALLAN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLAN
Last Name:KINGSTON
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 1:2231 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7434
Mailing Address - Country:US
Mailing Address - Phone:970-245-3208
Mailing Address - Fax:970-245-3947
Practice Address - Street 1:2231 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7434
Practice Address - Country:US
Practice Address - Phone:970-245-3208
Practice Address - Fax:970-245-3947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01219302Medicaid
COC6072Medicare PIN
COD24108Medicare UPIN