Provider Demographics
NPI:1710046776
Name:DIAMOND, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:DIAMOND
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 1:269 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-6654
Mailing Address - Country:US
Mailing Address - Phone:941-485-8315
Mailing Address - Fax:941-485-8523
Practice Address - Street 1:269 PORTOFINO DR
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-6654
Practice Address - Country:US
Practice Address - Phone:941-485-8315
Practice Address - Fax:941-485-8523
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90947OtherBLUE SHIELD
FL277350300Medicaid
MDD72050Medicare UPIN
FL277350300Medicaid