Provider Demographics
NPI:1497955611
Name:VALENZUELA, RICHARD GERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GERMAN
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:GERMAN
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7404
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-7404
Mailing Address - Country:US
Mailing Address - Phone:386-755-4007
Mailing Address - Fax:386-755-7098
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-755-4007
Practice Address - Fax:386-755-7098
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26245 R207X00000X
MI4301093240207XX0005X
FLME116272207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery