Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | K8458 | TX |
Y | 207Q00000X | Family Doctor | K8456 | TX |
NPI | 1043262330 |
---|---|
Provider Name | Paul Richter |
First Address | San Antonio, TX 78258-4541 |
Second Address | New Braunfels, TX 78130-4194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160311003 | (05) | TX |
H91769 | (02) | TX |