Provider Demographics
NPI:1114414018
Name:STAIR, RILEY FRANK (MD)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:FRANK
Last Name:STAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SUNRISE CT APT A
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-3104
Mailing Address - Country:US
Mailing Address - Phone:620-794-8119
Mailing Address - Fax:
Practice Address - Street 1:120 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2131
Practice Address - Country:US
Practice Address - Phone:620-225-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-46668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine