Provider Demographics
NPI:1962748871
Name:RICHARD, KARL MAX (PA-C)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:MAX
Last Name:RICHARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1085
Mailing Address - Country:US
Mailing Address - Phone:915-373-1230
Mailing Address - Fax:
Practice Address - Street 1:500 W OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1085
Practice Address - Country:US
Practice Address - Phone:915-373-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA64213363AM0700X
NC0010-6404363AM0700X
TXPA14624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical