Provider Demographics
NPI:1912950965
Name:PESIKOFF, RICHARD BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BERNARD
Last Name:PESIKOFF
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:PO BOX 540208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0208
Mailing Address - Country:US
Mailing Address - Phone:713-795-5424
Mailing Address - Fax:713-961-0008
Practice Address - Street 1:19 BRIAR HOLLOW LN
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-2819
Practice Address - Country:US
Practice Address - Phone:713-795-5424
Practice Address - Fax:713-961-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD66732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000M0242Medicaid
TXB25469Medicare UPIN
TXP000M0242Medicaid