Provider Demographics
NPI:1083676563
Name:VIRGILIO, RICHARD F (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:VIRGILIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2326
Mailing Address - Country:US
Mailing Address - Phone:214-941-4550
Mailing Address - Fax:214-941-4562
Practice Address - Street 1:214 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2326
Practice Address - Country:US
Practice Address - Phone:214-941-4550
Practice Address - Fax:214-941-4562
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175801301Medicaid
TX8P5412OtherBCBS
TX8P5412OtherBCBS
TX175801301Medicaid
TX8D9164Medicare PIN
TX8L19159Medicare PIN
TX8L17685Medicare PIN