Provider Demographics
NPI:1891066247
Name:BACHMAN, RICHARD KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:BACHMAN
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 1:540 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-5266
Mailing Address - Country:US
Mailing Address - Phone:863-676-8460
Mailing Address - Fax:
Practice Address - Street 1:540 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-5266
Practice Address - Country:US
Practice Address - Phone:863-676-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86975208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics