Provider Demographics
NPI:1215985015
Name:RICHARDS, CHERYL A (DO)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 HORIZON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7805
Mailing Address - Country:US
Mailing Address - Phone:972-772-5522
Mailing Address - Fax:469-402-1565
Practice Address - Street 1:3140 HORIZON RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7805
Practice Address - Country:US
Practice Address - Phone:972-772-5522
Practice Address - Fax:469-402-1565
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039773903Medicaid
TX039773906Medicaid
TX8G8478Medicare PIN
TXG21780Medicare UPIN
TXTXB123033Medicare PIN
TX039773903Medicaid