MEDICARE: RICHARD B. PESIKOFF, M.D. & ASSOCIATES

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	D6673	TX
2	2084P0800X	Psychiatry Physician	D6673	TX

General Provider Information

NPI Number	:	1538325600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD B. PESIKOFF, M.D. & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 540208
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0208
Country	:	US
Telephone Number	:	713-795-5424
Fax Number	:	713-961-0008

Provider Business Practice Location Address
First Line	:	24 GREENWAY PLZ
Second Line	:	SUITE 1204
City	:	HOUSTON
State	:	TX
Zip	:	77046-2401
Country	:	US
Telephone Number	:	713-795-5424
Fax Number	:	713-961-0008

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. RICHARD BERNARD PESIKOFF
Credential	:	M.D.
Telephone Number	:	713-795-5424

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	11/13/2008

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