Healthcare Provider Details

I. General information

NPI: 1588982201
Provider Name (Legal Business Name): RICHARD K CARDENAS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 CLEAR LAKE RD SUITE 100
WEATHERFORD TX
76086-5805
US

IV. Provider business mailing address

1429 CLEAR LAKE RD SUITE 100
WEATHERFORD TX
76086-5805
US

V. Phone/Fax

Practice location:
  • Phone: 817-598-1015
  • Fax: 817-599-3624
Mailing address:
  • Phone: 817-598-1015
  • Fax: 817-599-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG2525
License Number StateTX

VIII. Authorized Official

Name: CARRIE SMITH
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 972-701-8826