1386676104 NPI number — JONATHAN PATRICK RICHARD M.D., P.A.

Table of content: JONATHAN PATRICK RICHARD M.D., P.A. (NPI 1386676104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386676104 NPI number — JONATHAN PATRICK RICHARD M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARD
Provider First Name:
JONATHAN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARD
Provider Other First Name:
JONATHAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., P.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386676104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5009 THOMPSON TERRACE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-581-6800
Provider Business Mailing Address Fax Number:
817-581-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5009 THOMPSON TER
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034-5850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-581-6800
Provider Business Practice Location Address Fax Number:
817-581-6080
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G3730 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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