Provider Demographics
NPI:1003884792
Name:REMBECKI, RICHARD MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:REMBECKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 BOWIE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1542
Mailing Address - Country:US
Mailing Address - Phone:469-704-8696
Mailing Address - Fax:439-208-5333
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:800-755-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2461208000000X, 2080P0214X
NMMD2014-08732080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015857-0082OtherPACIFICARE
TX2934692002OtherCIGNA
TX0025KCOtherBLUE CROSS
TX2916754OtherAETNA
TX1151805-04Medicaid
TX3342580OtherBLUE LINK
TXA003OtherTRICARE
TX1151805-04Medicaid