Provider Demographics
NPI:1982656625
Name:HOSTLER, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HOSTLER
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 1:50 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6300
Mailing Address - Country:US
Mailing Address - Phone:863-293-2107
Mailing Address - Fax:863-298-8487
Practice Address - Street 1:50 2ND ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6300
Practice Address - Country:US
Practice Address - Phone:863-293-2107
Practice Address - Fax:863-298-8487
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067740000Medicaid
FL067740000Medicaid
FL05416YMedicare PIN