Provider Demographics
NPI:1568471134
Name:CALVIN, RICHARD EARL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:CALVIN
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 1:4727 SPINNAKER DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-8492
Mailing Address - Country:US
Mailing Address - Phone:941-748-4159
Mailing Address - Fax:
Practice Address - Street 1:4727 SPINNAKER DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-8492
Practice Address - Country:US
Practice Address - Phone:941-748-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17506207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84749Medicare UPIN