Provider Demographics
NPI:1902897309
Name:MAYER, RICHARD B II (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:MAYER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 S CREEK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9472
Mailing Address - Country:US
Mailing Address - Phone:606-348-3365
Mailing Address - Fax:606-348-8496
Practice Address - Street 1:1 S CREEK DR
Practice Address - Street 2:STE 102
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9472
Practice Address - Country:US
Practice Address - Phone:606-348-3365
Practice Address - Fax:606-348-8496
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64058084Medicaid
KY1282116Medicare PIN
KY64058084Medicaid