Provider Demographics
NPI:1134117641
Name:PHILIPS, RICHARD GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GARY
Last Name:PHILIPS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 NW 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4404
Mailing Address - Country:US
Mailing Address - Phone:954-345-9506
Mailing Address - Fax:
Practice Address - Street 1:936 NW 127TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4404
Practice Address - Country:US
Practice Address - Phone:954-345-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1906213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029704600Medicaid
FLT51199Medicare UPIN
FL029704600Medicaid