Provider Demographics
NPI:1326481151
Name:BRANDY RICARD, MD PA
Entity Type:Organization
Organization Name:BRANDY RICARD, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-3300
Mailing Address - Street 1:126 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8506
Mailing Address - Country:US
Mailing Address - Phone:903-723-3300
Mailing Address - Fax:903-723-3308
Practice Address - Street 1:126 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8506
Practice Address - Country:US
Practice Address - Phone:903-723-3300
Practice Address - Fax:903-723-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1811207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty