Provider Demographics
NPI:1902807704
Name:RICH, DONNA C (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:C
Last Name:RICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17625 EL CAMINO REAL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3052
Mailing Address - Country:US
Mailing Address - Phone:281-286-1000
Mailing Address - Fax:281-286-1100
Practice Address - Street 1:17625 EL CAMINO REAL
Practice Address - Street 2:SUITE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3052
Practice Address - Country:US
Practice Address - Phone:281-286-1000
Practice Address - Fax:281-286-1100
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX71000525531#Medicaid
TXG16421Medicare UPIN
TX71000525531#Medicaid