Provider Demographics
NPI:1881844785
Name:LEVADA, RICHARD JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:LEVADA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1421 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-249-9995
Mailing Address - Fax:830-249-9868
Practice Address - Street 1:1421 NORTH MAIN STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-249-9995
Practice Address - Fax:830-249-9868
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN1082457363A00000X
TXPA08381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant