Provider Demographics
NPI:1538325600
Name:RICHARD B. PESIKOFF, M.D. & ASSOCIATES
Entity type:Organization
Organization Name:RICHARD B. PESIKOFF, M.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:PESIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-5424
Mailing Address - Street 1:PO BOX 540208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0208
Mailing Address - Country:US
Mailing Address - Phone:713-795-5424
Mailing Address - Fax:713-961-0008
Practice Address - Street 1:24 GREENWAY PLZ
Practice Address - Street 2:SUITE 1204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-2401
Practice Address - Country:US
Practice Address - Phone:713-795-5424
Practice Address - Fax:713-961-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD66732084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty