Provider Demographics
NPI:1558399733
Name:RICHARDSON, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:RICHARDSON
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 1:700 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7314
Mailing Address - Country:US
Mailing Address - Phone:352-787-9838
Mailing Address - Fax:352-787-8705
Practice Address - Street 1:700 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7314
Practice Address - Country:US
Practice Address - Phone:352-787-9838
Practice Address - Fax:352-787-8705
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75610208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253935700Medicaid
FL42992OtherBCBS FL
FL42992AOtherBCBS FL
FL42992BOtherBCBS FL
FL42992VMedicare PIN
FL42992BOtherBCBS FL
FL42992XMedicare PIN
FL42992YMedicare PIN
FL42992ZMedicare PIN
FL42992Medicare PIN
FL42992AOtherBCBS FL
FL780001919Medicare PIN
FL42992OtherBCBS FL