Provider Demographics
NPI:1922029438
Name:LUDWIG, RICHARD EUGENE (PAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:353 ROYAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-9427
Mailing Address - Country:US
Mailing Address - Phone:407-370-2740
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:352-597-3008
Practice Address - Fax:352-597-3024
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33023Medicare UPIN