Provider Demographics
NPI:1568435246
Name:POSTLETHWAIT, RICHARD (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:POSTLETHWAIT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP NEUROSURGERY PEDIATRICS
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3660
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:UFJP NEUROSURGERY PEDIATRICS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-398-5021
Practice Address - Fax:904-244-3426
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA989816651AMedicaid
FL2916746-00Medicaid
FL2916746-00Medicaid
FLU1814ZMedicare PIN
FLU1814YMedicare PIN