Provider Demographics
NPI:1487629523
Name:DYCUS, RICHARD KERR II (DO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KERR
Last Name:DYCUS
Suffix:II
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 1:30 WINDSORMERE WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6512
Mailing Address - Country:US
Mailing Address - Phone:407-706-6688
Mailing Address - Fax:407-706-6691
Practice Address - Street 1:30 WINDSORMERE WAY
Practice Address - Street 2:STE 100
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6512
Practice Address - Country:US
Practice Address - Phone:407-706-6688
Practice Address - Fax:407-706-6691
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92034Medicare UPIN
71707ZMedicare ID - Type Unspecified