Provider Demographics
NPI:1184674988
Name:THOMAS-RICHARDS, JOSE R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:THOMAS-RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 EMERGENCY LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5536
Mailing Address - Country:US
Mailing Address - Phone:863-471-1511
Mailing Address - Fax:863-471-1512
Practice Address - Street 1:3750 EMERGENCY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5536
Practice Address - Country:US
Practice Address - Phone:863-471-1511
Practice Address - Fax:863-471-1512
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375820600Medicaid
FL80909WMedicare ID - Type Unspecified
FLE82020Medicare UPIN