Provider Demographics
NPI:1376546028
Name:SELLERS, RICHARD GRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GRAHAM
Last Name:SELLERS
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 1:4700 BAYOU BLVD STE 1C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2670
Mailing Address - Country:US
Mailing Address - Phone:850-916-9777
Mailing Address - Fax:850-916-0763
Practice Address - Street 1:4700 BAYOU BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2670
Practice Address - Country:US
Practice Address - Phone:850-916-9777
Practice Address - Fax:850-916-0763
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053098207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055627100Medicaid
FLD21137Medicare UPIN
FL055627100Medicaid