=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932170610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN J RILEY IV DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 03/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 NICHOLS RD SUITE 174
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64112-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-561-7388
-----------------------------------------------------
Fax | 816-561-9921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 NICHOLS RD SUITE 174
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64112-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-561-7388
-----------------------------------------------------
Fax | 816-561-9921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 595
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------