Provider Demographics
NPI:1235355587
Name:DUEY, RICHARD ELDON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ELDON
Last Name:DUEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6412207X00000X
TXN9540207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352418301Medicaid
TX454523ZRZAMedicare PIN
TX352418301Medicaid
TN103I209041Medicare PIN