Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | Q8134 | TX |
NPI | 1154610707 |
---|---|
Provider Name | Dr. Carter Malone Richards |
First Address | San Antonio, TX 78231-1272 |
Second Address | San Antonio, TX 78231-1272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 29/06/2016 |