Provider Demographics
NPI:1174533889
Name:HAENKE, RICHARD F (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:HAENKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:F
Other - Last Name:HAENKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2008 L DON DODSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1844
Mailing Address - Country:US
Mailing Address - Phone:817-571-9099
Mailing Address - Fax:817-571-5282
Practice Address - Street 1:2008 L DON DODSON DR STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-1844
Practice Address - Country:US
Practice Address - Phone:817-571-9099
Practice Address - Fax:817-571-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXG3423204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23243Medicare UPIN