Provider Demographics
NPI:1164403473
Name:RICHARDS, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:RICHARDS
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 1:1008 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2437
Mailing Address - Country:US
Mailing Address - Phone:850-215-3000
Mailing Address - Fax:850-215-3150
Practice Address - Street 1:1008 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2437
Practice Address - Country:US
Practice Address - Phone:850-215-3000
Practice Address - Fax:850-215-3150
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60114208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0042653000Medicaid
FL608500Medicaid
FL12421OtherBLUE CROSS
FL678471OtherWELLCARE
AL051555890OtherMEDICARE PROVIDER #
AL114684Medicaid
AL102I023970OtherMEDICARE GROUP/ PROVIDER PTAN
ALC70352OtherUPIN
FL678471OtherWELLCARE