Provider Demographics
NPI:1174531305
Name:JENNINGS, RICHARD LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1920 MEDI PARK DR
Mailing Address - Street 2:STE 3
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2104
Mailing Address - Country:US
Mailing Address - Phone:806-351-3477
Mailing Address - Fax:806-351-2601
Practice Address - Street 1:1920 MEDI PARK DR
Practice Address - Street 2:STE 3
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2104
Practice Address - Country:US
Practice Address - Phone:806-351-3477
Practice Address - Fax:806-351-2601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXFO255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0225OtherST LIC
TXF0225OtherST LIC
TXBJ1251420OtherDEA
TXC17439Medicare UPIN