Provider Demographics
NPI:1851893671
Name:DAKE, RICHARD TROY SR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TROY
Last Name:DAKE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226A SAINT JOE PLAZA DR # 144
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-3615
Mailing Address - Country:US
Mailing Address - Phone:386-259-3111
Mailing Address - Fax:
Practice Address - Street 1:226A SAINT JOE PLAZA DR # 144
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-3615
Practice Address - Country:US
Practice Address - Phone:386-259-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)