Provider Demographics
NPI:1558469619
Name:FEARS, RICHARD LARRY (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LARRY
Last Name:FEARS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:STE 170
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89010Medicare UPIN