Provider Demographics
NPI:1104977370
Name:SCHACK, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:SCHACK
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 1:175 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1524
Mailing Address - Country:US
Mailing Address - Phone:972-923-0281
Mailing Address - Fax:972-938-0171
Practice Address - Street 1:175 SAGEBRUSH LN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1524
Practice Address - Country:US
Practice Address - Phone:972-923-0281
Practice Address - Fax:972-938-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG20132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133721403Medicaid
TX00D85QMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
TX133721403Medicaid