Provider Demographics
NPI:1497259345
Name:RICHARDS, JAROD ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAROD
Middle Name:ALLEN
Last Name:RICHARDS
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-955-3312
Mailing Address - Fax:
Practice Address - Street 1:1905 W HEBRON LN
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7465
Practice Address - Country:US
Practice Address - Phone:502-955-3312
Practice Address - Fax:502-955-3313
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015205207X00000X
KY58994207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100638800Medicaid