Provider Demographics
NPI:1659384501
Name:BRAUCKMULLER, RICHARD FRANK
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANK
Last Name:BRAUCKMULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3403
Mailing Address - Country:US
Mailing Address - Phone:863-965-4410
Mailing Address - Fax:863-965-4412
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3403
Practice Address - Country:US
Practice Address - Phone:863-965-4410
Practice Address - Fax:863-965-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312636332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030897800Medicaid
FL030897800Medicaid