Provider Demographics
NPI:1992020440
Name:RICHARDSON, STEPHEN GUESS (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GUESS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7771
Mailing Address - Country:US
Mailing Address - Phone:512-805-5650
Mailing Address - Fax:512-392-4744
Practice Address - Street 1:401 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7771
Practice Address - Country:US
Practice Address - Phone:512-805-5650
Practice Address - Fax:512-392-4744
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3805207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01390909OtherRR MEDICARE
TX339722601Medicaid
36089YMG2OtherMEDICARE