Healthcare Provider Details

I. General information

NPI: 1497752885
Provider Name (Legal Business Name): TERRANCE P RIORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 MAINE ST
LAWRENCE KS
66044-1359
US

IV. Provider business mailing address

346 MAINE ST
LAWRENCE KS
66044-1359
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-4477
  • Fax: 785-842-7433
Mailing address:
  • Phone: 785-842-4477
  • Fax: 785-842-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420077
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100198050A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: