Healthcare Provider Details

I. General information

NPI: 1952567265
Provider Name (Legal Business Name): MARK J RICHARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

PO BOX 201088
HOUSTON TX
77216-1088
US

V. Phone/Fax

Practice location:
  • Phone: 713-704-4000
  • Fax:
Mailing address:
  • Phone: 713-500-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: