Healthcare Provider Details

I. General information

NPI: 1114273745
Provider Name (Legal Business Name): TRISTAN CYRUS RICHARDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5749 SAN FELIPE ST
HOUSTON TX
77057-3101
US

IV. Provider business mailing address

2925 BRIARPARK DR STE 575
HOUSTON TX
77042-3776
US

V. Phone/Fax

Practice location:
  • Phone: 832-957-6200
  • Fax: 281-895-3083
Mailing address:
  • Phone: 281-336-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA07762
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: