Provider Demographics
NPI:1285695924
Name:RICHMOND, KIM B (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:RICHMOND
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 1:5001 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 400 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:817-529-2667
Mailing Address - Fax:
Practice Address - Street 1:5001 SPRING VALLEY RD
Practice Address - Street 2:SUITE 400 EAST
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3946
Practice Address - Country:US
Practice Address - Phone:817-529-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7646207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0425Medicare PIN
TX8F0418Medicare PIN