Healthcare Provider Details

I. General information

NPI: 1003874181
Provider Name (Legal Business Name): MATTHEW B RICHINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CUNNINGHAM AVE STE 201
JOPLIN MO
64804-1542
US

IV. Provider business mailing address

PO BOX 3592
JOPLIN MO
64803-3592
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-7500
  • Fax: 417-782-7524
Mailing address:
  • Phone: 417-782-7500
  • Fax: 417-782-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number206009605
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: