Provider Demographics
NPI:1710082268
Name:VINSON, RICHARD PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PATRICK
Last Name:VINSON
Suffix:
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 1:8820 GATEWAY BLVD N
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1947
Mailing Address - Country:US
Mailing Address - Phone:915-759-7700
Mailing Address - Fax:915-759-7778
Practice Address - Street 1:8820 GATEWAY BLVD N
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1947
Practice Address - Country:US
Practice Address - Phone:915-759-7700
Practice Address - Fax:915-759-7778
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4601207N00000X, 207NI0002X, 207NS0135X, 207ND0900X, 207ND0101X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1777849-01Medicaid
TXG83637Medicare UPIN
TX1777849-01Medicaid