Provider Demographics
NPI:1932199205
Name:TAFF, RICHARD V (PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:TAFF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HIGHWAY 183 N
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2188
Mailing Address - Country:US
Mailing Address - Phone:254-643-0098
Mailing Address - Fax:
Practice Address - Street 1:2005 NORTH 183
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802
Practice Address - Country:US
Practice Address - Phone:325-643-3010
Practice Address - Fax:325-643-1063
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P71517Medicare UPIN
TX8G0837Medicare PIN