Provider Demographics
NPI:1063577377
Name:ABALLAY, RICHARD ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:ABALLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-772-2244
Practice Address - Street 1:620 W 8TH ST
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-2329
Practice Address - Country:US
Practice Address - Phone:620-659-3621
Practice Address - Fax:620-659-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAML002796207P00000X, 207Q00000X
WV22698207Q00000X
TN42991208D00000X
OK37440208D00000X
KS04-46567208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine