Provider Demographics
NPI:1407967961
Name:RICHARDS, MARRIE BYRNE (MD)
Entity Type:Individual
Prefix:
First Name:MARRIE
Middle Name:BYRNE
Last Name:RICHARDS
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 1:3400 BISSONNET STREET #297
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:713-667-8553
Mailing Address - Fax:713-667-8566
Practice Address - Street 1:3400 BISSONNET STREET #297
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005
Practice Address - Country:US
Practice Address - Phone:713-667-8553
Practice Address - Fax:713-667-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C21056Medicare UPIN
TXC21056Medicare UPIN
OOBJ98Medicare ID - Type Unspecified