Provider Demographics
NPI:1215093554
Name:S. RICHARD ROSKOS, MD, PA
Entity type:Organization
Organization Name:S. RICHARD ROSKOS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROSKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-252-1804
Mailing Address - Street 1:3500 OAK LAWN AVE
Mailing Address - Street 2:STE. 215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4348
Mailing Address - Country:US
Mailing Address - Phone:214-252-1804
Mailing Address - Fax:214-526-4610
Practice Address - Street 1:3500 OAK LAWN AVE
Practice Address - Street 2:STE. 215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4348
Practice Address - Country:US
Practice Address - Phone:214-252-1804
Practice Address - Fax:214-526-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG11782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035798001Medicaid
TX289028701Medicaid