Basic Information
| Provider Information | |||||||||
| NPI: | 1548484611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722342987 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S HENDERSON ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174131500 | ||||||||
| FaxNumber: | 8174131499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M6360 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | M6360 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | M6360 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 188271405 | 05 | TX | MEDICAID | P00998372 | 01 | TX | RAILROAD MEDICARE | OTHER | 8W6313 | 01 | TX | BCBS | OTHER | 188271406 | 05 | TX | MEDICAID |