Provider Demographics
NPI:1689741712
Name:RICH, NICOLAS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:RICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N. KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-544-4484
Mailing Address - Fax:915-544-4590
Practice Address - Street 1:2900 N. KANSAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-544-4484
Practice Address - Fax:915-544-4590
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130502107Medicaid
F41958Medicare UPIN