Provider Demographics
NPI:1801887047
Name:HANNIGAN, RICHARD EDWARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:HANNIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12447 NETWORK BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3540
Mailing Address - Country:US
Mailing Address - Phone:210-258-4625
Mailing Address - Fax:877-479-3805
Practice Address - Street 1:12447 NETWORK BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3540
Practice Address - Country:US
Practice Address - Phone:210-258-4625
Practice Address - Fax:877-479-3805
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156602OtherWELLMED NETWORKS INC
TXTXB111039OtherWELLMED MEDICAL GROUP PA