Provider Demographics
NPI:1508142258
Name:STOUGHTON, RICHARD RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RALPH
Last Name:STOUGHTON
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 1:5005 TWIN PINE DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-7914
Mailing Address - Country:US
Mailing Address - Phone:813-713-9343
Mailing Address - Fax:
Practice Address - Street 1:5005 TWIN PINE DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-7914
Practice Address - Country:US
Practice Address - Phone:813-713-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19803-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19803-020OtherWISCONSIN MEDICAL LICENSE