Provider Demographics
NPI:1063447449
Name:MILGRIM, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:MILGRIM
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:PO BOX 740177
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-0177
Mailing Address - Country:US
Mailing Address - Phone:561-740-2900
Mailing Address - Fax:561-434-0598
Practice Address - Street 1:4675 LINTON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6615
Practice Address - Country:US
Practice Address - Phone:561-496-0808
Practice Address - Fax:561-496-3728
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042323207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61297ZMedicare ID - Type Unspecified
D65263Medicare UPIN