Provider Demographics
NPI:1528383916
Name:RICHARD M. BOATMAN, MD, PA
Entity Type:Organization
Organization Name:RICHARD M. BOATMAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-542-2673
Mailing Address - Street 1:1441 REDBUD BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3271
Mailing Address - Country:US
Mailing Address - Phone:972-542-2673
Mailing Address - Fax:972-562-9506
Practice Address - Street 1:1441 REDBUD BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3271
Practice Address - Country:US
Practice Address - Phone:972-542-2673
Practice Address - Fax:972-562-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115947702Medicaid
TXB21340Medicare UPIN
TX00SR36Medicare PIN