Provider Demographics
NPI:1003866377
Name:VERA, RICHARD LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LUIS
Last Name:VERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1615 LANCASTER DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2111
Mailing Address - Country:US
Mailing Address - Phone:817-421-0279
Mailing Address - Fax:817-416-7490
Practice Address - Street 1:1615 LANCASTER DR
Practice Address - Street 2:SUITE #150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2111
Practice Address - Country:US
Practice Address - Phone:817-421-0279
Practice Address - Fax:817-416-7490
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1583207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036053-01Medicaid
TX036053-01Medicaid
TX8C2006Medicare PIN