Provider Demographics
NPI:1750315511
Name:RICHARD, THOMAS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:RICHARD
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 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-0801
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:1800 AL HWY 157
Practice Address - Street 2:SUITE 302
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0600
Practice Address - Country:US
Practice Address - Phone:256-736-6224
Practice Address - Fax:256-736-6226
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000021859Medicaid
AL000021859Medicaid
AL000021859Medicare ID - Type Unspecified