Provider Demographics
NPI:1760466767
Name:BAKST, RICHARD H (DPM PA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BAKST
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 ALTERNATE A1A
Mailing Address - Street 2:118
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2205
Mailing Address - Country:US
Mailing Address - Phone:561-626-3338
Mailing Address - Fax:561-776-3100
Practice Address - Street 1:12300 ALTERNATE A1A
Practice Address - Street 2:118
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-626-3338
Practice Address - Fax:561-776-3100
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1653213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT 34363Medicare UPIN
FL65048Medicare ID - Type Unspecified