Provider Demographics
NPI:1730111287
Name:RYCUS, JOSHUA MARC (DO,PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARC
Last Name:RYCUS
Suffix:
Gender:M
Credentials:DO,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 NW 33RD ST
Mailing Address - Street 2:SUITE # 114
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4042
Mailing Address - Country:US
Mailing Address - Phone:954-753-1477
Mailing Address - Fax:954-753-3626
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:SUITE # 114
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-753-1477
Practice Address - Fax:954-753-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8863207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1047954OtherCAREPLUS
FL1758777OtherCIGNA PROVIDER #
FL48268OtherBC/BS PROVIDER #
FL0101381OtherUNITED HEALTH PROVIDER #
FL269335600Medicaid
FL295499OtherAVMED PROVIDER #
FL50806OtherNEIGHBORHOOD PROVIDER#
FL48268Medicare ID - Type Unspecified