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General NPI Number Information
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NPI Number | 1841265915
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Entity Type | Organization
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Legal Business Name | PHYSICIANS CENTER PA
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 3721 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-2401
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Country | US
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Telephone | 512-869-7310
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Fax | 512-869-5616
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Provider Business Mailing Address
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Address Line | 3721 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-2401
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Country | US
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Telephone | 512-869-7310
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Fax | 512-869-5616
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD C MALE JR.
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Credential | D.O.
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Telephone | 512-869-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H8460
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01421
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA01580
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04980
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H8229
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License Number State | TX
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