Provider Demographics
NPI:1821099516
Name:RICHE, RANDALL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:PAUL
Last Name:RICHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 BAYOU BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2670
Mailing Address - Country:US
Mailing Address - Phone:850-432-9698
Mailing Address - Fax:850-432-9453
Practice Address - Street 1:4700 BAYOU BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2670
Practice Address - Country:US
Practice Address - Phone:850-432-9698
Practice Address - Fax:850-432-9453
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59729207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME59729OtherFL MEDICAL LICENSE
FL110050097OtherRAILROAD MEDICARE
AL59089541OtherAL BS
FL054691700Medicaid
FL054691700Medicaid
FL12103Medicare PIN