Provider Demographics
NPI:1326102591
Name:SCHELLIN, RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SCHELLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 LOST CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3656
Mailing Address - Country:US
Mailing Address - Phone:817-244-0904
Mailing Address - Fax:
Practice Address - Street 1:3904 LOST CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-3656
Practice Address - Country:US
Practice Address - Phone:817-244-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDOG75822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00110017OtherPALMETTO
TX0089KJOtherBCBS
TX132273707Medicaid
TX10029312OtherAMERIGROUP
TXDOG7582OtherLIC NUMBER
TXDOG7582OtherLIC NUMBER
TX610288Medicare ID - Type Unspecified