Provider Demographics
NPI:1578562278
Name:STERN, RICHARD LEO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEO
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12740 HILLCREST RD STE 265
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2086
Mailing Address - Country:US
Mailing Address - Phone:972-513-1410
Mailing Address - Fax:469-565-9885
Practice Address - Street 1:12740 HILLCREST RD STE 265
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2086
Practice Address - Country:US
Practice Address - Phone:972-513-1410
Practice Address - Fax:469-565-9885
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7909174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A5345Medicare PIN
TXH43573Medicare UPIN