Provider Demographics
NPI:1700802576
Name:BELLACOSA, RICHARD A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BELLACOSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-692-9203
Mailing Address - Fax:210-692-0028
Practice Address - Street 1:14615 SAN PEDRO AVE
Practice Address - Street 2:160
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4321
Practice Address - Country:US
Practice Address - Phone:210-490-1871
Practice Address - Fax:210-490-1878
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0831213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11058431Medicaid
TX11058431Medicaid
TXT12158Medicare UPIN