Provider Demographics
NPI:1952869901
Name:BEAR, RICHARD CONRAD III
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CONRAD
Last Name:BEAR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-8300
Mailing Address - Fax:
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-1000
Practice Address - Fax:281-737-2945
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139939363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX396726701Medicaid