Healthcare Provider Details

I. General information

NPI: 1578562278
Provider Name (Legal Business Name): RICHARD LEO STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/24/2024
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12740 HILLCREST RD STE 265
DALLAS TX
75230-2086
US

IV. Provider business mailing address

12740 HILLCREST RD STE 265
DALLAS TX
75230-2086
US

V. Phone/Fax

Practice location:
  • Phone: 972-513-1410
  • Fax: 469-565-9885
Mailing address:
  • Phone: 972-513-1410
  • Fax: 469-565-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK7909
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberK7909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: