Healthcare Provider Details

I. General information

NPI: 1447223086
Provider Name (Legal Business Name): RICHARD G SPITZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S AVENUE T
CLIFTON TX
76634-1855
US

IV. Provider business mailing address

PO BOX 72
CLIFTON TX
76634-0072
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-8621
  • Fax: 254-675-2254
Mailing address:
  • Phone: 254-675-8621
  • Fax: 254-675-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD9677
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: