Provider Demographics
NPI:1194195123
Name:RICHARD E DUEY MD PA
Entity Type:Organization
Organization Name:RICHARD E DUEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-200-7236
Mailing Address - Street 1:PO BOX 2146
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78297-2146
Mailing Address - Country:US
Mailing Address - Phone:210-481-1700
Mailing Address - Fax:210-481-1705
Practice Address - Street 1:110 E BANDERA RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2802
Practice Address - Country:US
Practice Address - Phone:210-481-1700
Practice Address - Fax:210-481-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352417501Medicaid
TX454522Medicare PIN