Provider Demographics
NPI:1114273745
Name:RICHARDS, TRISTAN CYRUS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:CYRUS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 BRIARPARK DR STE 575
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3776
Mailing Address - Country:US
Mailing Address - Phone:281-336-0552
Mailing Address - Fax:
Practice Address - Street 1:5749 SAN FELIPE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3101
Practice Address - Country:US
Practice Address - Phone:832-957-6200
Practice Address - Fax:281-895-3083
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07762207Q00000X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical