Provider Demographics
NPI:1508944950
Name:STRAHAN, RICHARD JASON (M D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JASON
Last Name:STRAHAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LAKEVIEW AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1857
Mailing Address - Country:US
Mailing Address - Phone:850-908-6993
Mailing Address - Fax:850-908-6992
Practice Address - Street 1:1201 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1857
Practice Address - Country:US
Practice Address - Phone:850-908-6993
Practice Address - Fax:850-908-6992
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280917600Medicaid
FL280917600Medicaid