Provider Demographics
NPI:1124009337
Name:CHILDERS, RICHARD L (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 CALLAGHAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1106
Mailing Address - Country:US
Mailing Address - Phone:210-227-8700
Mailing Address - Fax:210-348-9130
Practice Address - Street 1:28590 IH 10 WEST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-981-5150
Practice Address - Fax:830-981-5159
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0930213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130989007Medicaid
TX8D1393OtherBCBS
TXT78945Medicare UPIN
TX8D1393Medicare ID - Type Unspecified