Provider Demographics
NPI:1710956206
Name:EATROFF, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:EATROFF
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 1:510 VONDERBURG DR
Mailing Address - Street 2:SUITE 3005
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5980
Mailing Address - Country:US
Mailing Address - Phone:813-685-5000
Mailing Address - Fax:813-681-1695
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 3005
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5980
Practice Address - Country:US
Practice Address - Phone:813-685-5000
Practice Address - Fax:813-681-1695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30125Medicare ID - Type Unspecified
FLD53866Medicare UPIN