Provider Demographics
NPI:1467442848
Name:BANG, RICHARD CHO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHO
Last Name:BANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 MCPHERSON RD STE 117
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6505
Mailing Address - Country:US
Mailing Address - Phone:956-796-4990
Mailing Address - Fax:956-722-3113
Practice Address - Street 1:7210 MCPHERSON RD STE 117
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6505
Practice Address - Country:US
Practice Address - Phone:956-796-4990
Practice Address - Fax:956-722-3113
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B1451Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TXH93350Medicare UPIN