Provider Demographics
NPI:1467559666
Name:RICHARD D YENTIS MD FAACP PA
Entity Type:Organization
Organization Name:RICHARD D YENTIS MD FAACP PA
Other - Org Name:RICHARD YENTIS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-988-8426
Mailing Address - Street 1:2615 SIMONDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1245
Mailing Address - Country:US
Mailing Address - Phone:817-926-6621
Mailing Address - Fax:817-336-7124
Practice Address - Street 1:4388 W VICKERY BLVD
Practice Address - Street 2:STE 203
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6339
Practice Address - Country:US
Practice Address - Phone:817-988-8426
Practice Address - Fax:817-336-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD53332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27732Medicare UPIN