Provider Demographics
NPI:1104127588
Name:DR RICHARD T. KILBY, M.D. LLC
Entity type:Organization
Organization Name:DR RICHARD T. KILBY, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-339-9737
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR STE 280
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2971
Mailing Address - Country:US
Mailing Address - Phone:907-339-9737
Mailing Address - Fax:907-339-9720
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 280
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2971
Practice Address - Country:US
Practice Address - Phone:907-339-9737
Practice Address - Fax:907-339-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK906292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0309Medicaid