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General NPI Number Information
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NPI Number | 1114334919
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Entity Type | Organization
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Legal Business Name | JONATHAN RICHARD, M.D., P.A.
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 5009 THOMPSON TER #102
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5850
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Country | US
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Telephone | 817-581-6800
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Fax | 817-581-6080
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Provider Business Mailing Address
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Address Line | 5009 THOMPSON TER #102
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5850
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Country | US
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Telephone | 817-581-6800
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Fax | 817-581-6080
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN RICHARD
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Credential | M.D.
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Telephone | 817-581-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G3730
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License Number State | TX
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