Provider Demographics
NPI:1790771715
Name:TAY, RICHARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:TAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1905 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1814
Mailing Address - Country:US
Mailing Address - Phone:254-298-2682
Mailing Address - Fax:254-778-7197
Practice Address - Street 1:1717 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1838
Practice Address - Country:US
Practice Address - Phone:254-298-2682
Practice Address - Fax:254-778-7197
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1796207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042440001Medicaid
F33133Medicare UPIN
83G561Medicare ID - Type Unspecified