Provider Demographics
NPI:1457686768
Name:RICHARD R ONDRIZEK MD PA
Entity Type:Organization
Organization Name:RICHARD R ONDRIZEK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ONDRIZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-568-1981
Mailing Address - Street 1:914 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3340
Mailing Address - Country:US
Mailing Address - Phone:817-568-1981
Mailing Address - Fax:817-568-9714
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:SUITE 242
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-568-1981
Practice Address - Fax:817-568-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030252301Medicaid
TX030252301Medicaid
G80253Medicare UPIN