Provider Demographics
NPI:1710973995
Name:RICHMOND, CHARLES HUNTER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HUNTER
Last Name:RICHMOND
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 1:204 MEDICAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6374
Mailing Address - Country:US
Mailing Address - Phone:903-771-7503
Mailing Address - Fax:903-771-7821
Practice Address - Street 1:204 MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6374
Practice Address - Country:US
Practice Address - Phone:903-771-7503
Practice Address - Fax:903-771-7821
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2280207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ2280OtherSTATE LICENSE
TX4492270OtherAETNA
TX752546971002OtherTRICARE
TX3380289OtherBLUELINK
TX6826666002OtherCIGNA
TXN60HOtherBCBS
TX035052201Medicaid
TX6826666002OtherCIGNA
TXF80289Medicare UPIN