Provider Demographics
NPI:1891767596
Name:GOLUB, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:GOLUB
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 1:3333 CATTLEMEN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6058
Mailing Address - Country:US
Mailing Address - Phone:941-341-0042
Mailing Address - Fax:941-342-3432
Practice Address - Street 1:3333 CATTLEMEN RD STE 206
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6058
Practice Address - Country:US
Practice Address - Phone:941-341-0042
Practice Address - Fax:941-342-3432
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85935208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47961OtherFL BC/BS
FL47961ZMedicare PIN
E94802Medicare UPIN