Provider Demographics
NPI:1235181777
Name:SIX, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:SIX
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 1:618 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6366
Mailing Address - Country:US
Mailing Address - Phone:772-463-8256
Mailing Address - Fax:772-463-7795
Practice Address - Street 1:618 VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6366
Practice Address - Country:US
Practice Address - Phone:772-463-8256
Practice Address - Fax:772-463-7795
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00308582085R0202X
TXD66842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165976507Medicaid
FL0451894-00Medicaid
TX8K1345Medicare PIN
FL0451894-00Medicaid
TX165976507Medicaid