Provider Demographics
NPI:1649279670
Name:PAGE, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:PAGE
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 1:2380 FIREWHEEL PKWY
Mailing Address - Street 2:STE. 1100
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4004
Mailing Address - Country:US
Mailing Address - Phone:972-271-6811
Mailing Address - Fax:972-278-6589
Practice Address - Street 1:2380 FIREWHEEL PKWY
Practice Address - Street 2:STE. 1100
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4004
Practice Address - Country:US
Practice Address - Phone:972-271-6811
Practice Address - Fax:972-278-6589
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-01-30
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXK4977207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0298382-01Medicaid
TX0041CLOtherBC/BS OF TEXAS PROVIDER
TX0041CLOtherBC/BS OF TEXAS PROVIDER
C51876Medicare UPIN