Provider Demographics
NPI:1366548257
Name:RICHEY, L E (MD)
Entity type:Individual
Prefix:
First Name:L
Middle Name:E
Last Name:RICHEY
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 2569
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2569
Mailing Address - Country:US
Mailing Address - Phone:713-664-1330
Mailing Address - Fax:713-664-3355
Practice Address - Street 1:4411 BLUEBONNET DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2912
Practice Address - Country:US
Practice Address - Phone:713-664-1330
Practice Address - Fax:713-664-3355
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC45172085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE21027Medicare UPIN