Provider Demographics
NPI:1578524484
Name:RIZZUTO, DAVID RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDOLPH
Last Name:RIZZUTO
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:PO BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-273-7839
Mailing Address - Fax:352-273-8172
Practice Address - Street 1:732 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4442
Practice Address - Country:US
Practice Address - Phone:352-265-8356
Practice Address - Fax:352-787-0854
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95008207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37068OtherBCBS OF FL
FL274650600Medicaid
FL37068ZMedicare PIN