Provider Demographics
NPI:1720007537
Name:FALKENBERG, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:FALKENBERG
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 1:11531 SE US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4429
Mailing Address - Country:US
Mailing Address - Phone:352-553-1669
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:11531 SE US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4429
Practice Address - Country:US
Practice Address - Phone:352-553-1669
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041914100Medicaid
FL53799Medicare PIN
FL041914100Medicaid