Provider Demographics
NPI:1821098526
Name:EHLERS, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:EHLERS
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 1:18100 SAINT JOHN DR
Mailing Address - Street 2:STE. 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3631
Mailing Address - Country:US
Mailing Address - Phone:713-563-0670
Mailing Address - Fax:
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:STE. 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:713-563-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL28742086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153932203Medicaid
TX153932204Medicaid
TXP00476504OtherRAILROAD MEDICARE
TX153932202Medicaid
TX8C0438Medicare ID - Type Unspecified
TXP00476504OtherRAILROAD MEDICARE
TX8F7560Medicare PIN
TX153932203Medicaid