Provider Demographics
NPI:1124652813
Name:RICHARDS, SUSAN RAE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BOYD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3326
Mailing Address - Country:US
Mailing Address - Phone:214-244-0099
Mailing Address - Fax:
Practice Address - Street 1:2720 VIRGINIA PKWY STE 500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4963
Practice Address - Country:US
Practice Address - Phone:972-542-1205
Practice Address - Fax:877-428-7293
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine