Healthcare Provider Details

I. General information

NPI: 1669503363
Provider Name (Legal Business Name): RICHARD F MCCONNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 W PARK ROW DR
PANTEGO TX
76013-2050
US

IV. Provider business mailing address

3008 W PARK ROW DR
PANTEGO TX
76013-2050
US

V. Phone/Fax

Practice location:
  • Phone: 817-861-5522
  • Fax: 817-861-3525
Mailing address:
  • Phone: 817-861-5522
  • Fax: 817-861-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD-8340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: