Basic Information
Provider Information
NPI: 1003802703
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCRIVEN
FirstName: RICHARD
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4300 CITY POINT DR
Address2: SUITE 201
City: NORTH RICHLAND HILLS
State: TX
PostalCode: 761808380
CountryCode: US
TelephoneNumber: 8177848268
FaxNumber: 8175902285
Practice Location
Address1: 4300 CITY POINT DR
Address2: SUITE 201
City: NORTH RICHLAND HILLS
State: TX
PostalCode: 761808380
CountryCode: US
TelephoneNumber: 8177848268
FaxNumber: 8175902285
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 06/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000XL0579TXY Allopathic & Osteopathic PhysiciansUrology 

ID Information
IDTypeStateIssuerDescription
10072470505TX MEDICAID
10072470405TX MEDICAID
10072470105TX MEDICAID
10072470305TX MEDICAID
10072470205TX MEDICAID


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