Provider Demographics
NPI:1063436947
Name:RICH, BRIAN KEITH (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:RICH
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 1:4020 N MACARTHUR BLVD STE 122-321
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6419
Mailing Address - Country:US
Mailing Address - Phone:214-395-1891
Mailing Address - Fax:
Practice Address - Street 1:1816 S FM 51 STE 800
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3792
Practice Address - Country:US
Practice Address - Phone:940-263-0005
Practice Address - Fax:877-292-3457
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24887207P00000X, 207QS0010X, 208VP0014X
TXS9055208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200093580AMedicaid