Provider Demographics
NPI:1750327862
Name:MAUK, RICHARD H (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:MAUK
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 1:4637 MARBELLA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-1927
Mailing Address - Country:US
Mailing Address - Phone:817-733-6566
Mailing Address - Fax:
Practice Address - Street 1:950 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4501
Practice Address - Country:US
Practice Address - Phone:817-336-5060
Practice Address - Fax:817-336-1744
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2284207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10028773OtherAMERIGROUP
TX118141401Medicaid
1634476OtherUNISYS LOUISIANA MEDICAID
4036862OtherAETNA
834766OtherBLUE CROSS BLUE SHIELD TX
110081715OtherMEDICARE RAILROAD
834766OtherBLUE CROSS BLUE SHIELD TX
TX118141401Medicaid