Provider Demographics
NPI:1629355532
Name:DYCUS FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:DYCUS FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KERR
Authorized Official - Last Name:DYCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-706-6688
Mailing Address - Street 1:30 WINDSORMERE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6512
Mailing Address - Country:US
Mailing Address - Phone:407-706-6688
Mailing Address - Fax:407-706-6691
Practice Address - Street 1:30 WINDSORMERE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6512
Practice Address - Country:US
Practice Address - Phone:407-706-6688
Practice Address - Fax:407-706-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0008481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH92034Medicare UPIN
FL71707ZMedicare PIN