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NPI Code Detail

MEDICARE: DR. RICHARD JOHN DUSOLD M.D.

MEDICARE: DR. RICHARD JOHN DUSOLD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianH4299TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181X064OTHERTXBLUE SHIELD

General Provider Information

NPI Number : 1366402182
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD JOHN DUSOLD M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-8800
Fax Number :
Provider Business Practice Location Address
First Line : 1700 UNIVERSITY DR E
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77840-2661
Country : US
Telephone Number : 409-691-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 01/07/2021

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