Provider Demographics
NPI:1639338270
Name:ANAYA, RICHARD JOHN (PAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:ANAYA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2022 MURCHISON DR 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3058
Mailing Address - Country:US
Mailing Address - Phone:915-533-5388
Mailing Address - Fax:915-533-0868
Practice Address - Street 1:7920 DONIPHAN DR
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:TX
Practice Address - Zip Code:79821-7628
Practice Address - Country:US
Practice Address - Phone:915-886-3399
Practice Address - Fax:915-886-2999
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical