MEDICARE: RICHARD M LACKRITZ, MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	F1102	TX

General Provider Information

NPI Number	:	1114199312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD M LACKRITZ, MDPA

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR STE 230
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-615-0866
Fax Number	:	210-615-8321

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 230
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-615-0866
Fax Number	:	210-615-8321

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ELIZABETH ANN MCCLENDON
Credential	:
Telephone Number	:	210-615-0866

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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