Provider Demographics
NPI:1770520942
Name:RICH, JON M (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:RICH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-3638
Mailing Address - Country:US
Mailing Address - Phone:903-309-9373
Mailing Address - Fax:903-405-4573
Practice Address - Street 1:2412 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3638
Practice Address - Country:US
Practice Address - Phone:903-309-9373
Practice Address - Fax:903-405-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181600102Medicaid
TX86241YOtherBCBS PROVIDER NUMBER
TX86241YOtherBCBS PROVIDER NUMBER
TXI59676Medicare UPIN