Healthcare Provider Details

I. General information

NPI: 1093710113
Provider Name (Legal Business Name): JON KEVIN RICHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 STATE HIGHWAY 265
BRANSON MO
65616-9099
US

IV. Provider business mailing address

PO BOX 505673
SAINT LOUIS MO
63150-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-338-0960
  • Fax: 417-338-0968
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024021907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: