Provider Demographics
NPI:1205946340
Name:ALFORD, RICHARD D (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:ALFORD
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 S TEXAS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:979-774-2061
Mailing Address - Fax:979-776-5915
Practice Address - Street 1:2700 E 29TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2507
Practice Address - Country:US
Practice Address - Phone:979-776-5631
Practice Address - Fax:979-776-6184
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7969174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120415806Medicaid
TXE19038Medicare UPIN
TXE19038Medicare UPIN
TX80121NOtherBLUE CROSS BLUE SHIELD