Provider Demographics
NPI:1073600433
Name:MAU, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:MAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4437
Mailing Address - Country:US
Mailing Address - Phone:936-559-0711
Mailing Address - Fax:936-559-0732
Practice Address - Street 1:1004 N MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4437
Practice Address - Country:US
Practice Address - Phone:936-559-0711
Practice Address - Fax:936-559-0732
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4144207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2132098OtherBLUE LINK ID
TX752729878OtherTAX ID
TX0307589Medicaid
TX0062BXMedicare PIN
TX2132098OtherBLUE LINK ID