Provider Demographics
NPI:1649221755
Name:BEATTY, RICHARD F (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:BEATTY
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 11392
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:866-949-1433
Mailing Address - Fax:
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:239-348-4203
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0093154207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272570300Medicaid
FL16067YMedicare PIN
FLD24480Medicare UPIN