Provider Demographics
NPI:1104821800
Name:DAVID, RICHARD T (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:DAVID
Suffix:
Gender:
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 1610
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9004
Mailing Address - Country:US
Mailing Address - Phone:903-603-7067
Mailing Address - Fax:903-603-7595
Practice Address - Street 1:115 MEDICAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-603-7067
Practice Address - Fax:903-603-7595
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136259201Medicaid
TX80F793OtherBCBS
TXC15034Medicare UPIN
TX80F793Medicare ID - Type UnspecifiedMEDICARE NUMBER