Provider Demographics
NPI:1386647048
Name:RICHIE-GILLESPIE, MAYME (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYME
Middle Name:
Last Name:RICHIE-GILLESPIE
Suffix:
Gender:F
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 26979
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0979
Mailing Address - Country:US
Mailing Address - Phone:817-688-0920
Mailing Address - Fax:
Practice Address - Street 1:1250 8TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4121
Practice Address - Country:US
Practice Address - Phone:817-702-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH27232086X0206X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU41HOtherBCBS
TX138940505Medicaid
TX138940505Medicaid
8F8955Medicare PIN
TXE99874Medicare UPIN