Provider Demographics
NPI:1275521585
Name:RICHMOND, CLIFF M (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:M
Last Name:RICHMOND
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 1:9600 DATAPOINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2028
Mailing Address - Country:US
Mailing Address - Phone:210-892-3700
Mailing Address - Fax:210-614-4659
Practice Address - Street 1:2728 BABCOCK ROAD
Practice Address - Street 2:PATH DEPT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-705-6463
Practice Address - Fax:210-705-6488
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3731207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00RM40OtherMEDICARE
TX134208105Medicaid
TX134208105Medicaid
81P531Medicare ID - Type Unspecified