Provider Demographics
NPI:1508004235
Name:RICHARD L VAN BUSKIRK D O P A
Entity Type:Organization
Organization Name:RICHARD L VAN BUSKIRK D O P A
Other - Org Name:RICHARD L. VAN BUSKIRK, D.O., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LONGWILL
Authorized Official - Last Name:VAN BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-924-1729
Mailing Address - Street 1:2900 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5133
Mailing Address - Country:US
Mailing Address - Phone:941-924-1729
Mailing Address - Fax:941-927-9375
Practice Address - Street 1:2900 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5133
Practice Address - Country:US
Practice Address - Phone:941-924-1729
Practice Address - Fax:941-927-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005899204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184698128Medicare UPIN