Provider Demographics
NPI:1871520783
Name:BOATMAN, RICHARD MARTIN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARTIN
Last Name:BOATMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 REDBUD BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 REDBUD BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3234
Practice Address - Country:US
Practice Address - Phone:972-542-3364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115947704Medicaid
TX115947702Medicaid
TX115947702Medicaid
TXTXB148656Medicare PIN
B21340Medicare UPIN
TX00SR36Medicare ID - Type Unspecified