Healthcare Provider Details

I. General information

NPI: 1558755884
Provider Name (Legal Business Name): RICHARD DAVID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 E VISTAWOOD DR
HOUSTON TX
77077-3230
US

IV. Provider business mailing address

1307 E VISTAWOOD DR
HOUSTON TX
77077-3230
US

V. Phone/Fax

Practice location:
  • Phone: 832-677-5007
  • Fax:
Mailing address:
  • Phone: 832-677-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: