Healthcare Provider Details

I. General information

NPI: 1477524049
Provider Name (Legal Business Name): DENNIS J RICHARDS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/21/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SAVANNAH AVE STE. 101 & 102 BLDG. C
MCALLEN TX
78503-1242
US

IV. Provider business mailing address

110 E SAVANNAH AVE BLDG C101
MCALLEN TX
78503-1242
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-2626
  • Fax: 956-686-1616
Mailing address:
  • Phone: 956-686-2626
  • Fax: 956-686-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number678383
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP111070
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: