Provider Demographics
NPI:1134129596
Name:MALE, RICHARD C JR (DO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:MALE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3721 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2401
Mailing Address - Country:US
Mailing Address - Phone:512-869-7310
Mailing Address - Fax:512-869-5616
Practice Address - Street 1:3721 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2401
Practice Address - Country:US
Practice Address - Phone:512-869-7310
Practice Address - Fax:512-869-5616
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137536207Medicaid
TX89M682Medicare ID - Type Unspecified
TX137536207Medicaid