Provider Demographics
NPI:1952397077
Name:PIATT, GUADALUPE RICHTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:RICHTER
Last Name:PIATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GUADALUPE
Other - Middle Name:ELISABETH
Other - Last Name:RICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12221 N MOPAC EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:
Practice Address - Street 1:8210 CEDAR CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-4411
Practice Address - Country:US
Practice Address - Phone:512-201-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203087208000000X
TXP4692208000000X
TN39865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1807303Medicaid
TX304480YR93Medicare PIN
LA1807303Medicaid
TXI39748Medicare UPIN