Provider Demographics
NPI:1548484611
Name:RICHEY, STEPHEN LANE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LANE
Last Name:RICHEY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:500 S HENDERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2154
Practice Address - Country:US
Practice Address - Phone:817-413-1500
Practice Address - Fax:817-413-1499
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6360207R00000X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188271405Medicaid
TXP00998372OtherRAILROAD MEDICARE
TX8W6313OtherBCBS
TX188271406Medicaid
TX8W6313OtherBCBS
TXTXB132332Medicare PIN
TXTXB132324Medicare PIN
TX8W6313OtherBCBS