Healthcare Provider Details

I. General information

NPI: 1003884792
Provider Name (Legal Business Name): RICHARD MICHAEL REMBECKI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571
US

IV. Provider business mailing address

1394 BOWIE LN
FRISCO TX
75033-1542
US

V. Phone/Fax

Practice location:
  • Phone: 800-755-6236
  • Fax:
Mailing address:
  • Phone: 469-704-8696
  • Fax: 439-208-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2461
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD2014-0873
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberJ2461
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2014-0873
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: