Provider Demographics
NPI:1467444943
Name:MEJIA, RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:MEJIA
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:PO BOX 749539
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9539
Mailing Address - Country:US
Mailing Address - Phone:561-748-0510
Mailing Address - Fax:561-748-0598
Practice Address - Street 1:2101 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7321
Practice Address - Country:US
Practice Address - Phone:561-748-0510
Practice Address - Fax:561-748-0598
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78182207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46587WMedicare ID - Type UnspecifiedMDCRPROVIDER NUMBER
FL46587YMedicare PIN
FLH00344Medicare UPIN