Provider Demographics
NPI:1134242787
Name:RICHARD W SPRINGSTEAD MD PA
Entity type:Organization
Organization Name:RICHARD W SPRINGSTEAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3527-962-0324
Mailing Address - Street 1:33 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3217
Mailing Address - Country:US
Mailing Address - Phone:352-796-0324
Mailing Address - Fax:352-544-0801
Practice Address - Street 1:33 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3217
Practice Address - Country:US
Practice Address - Phone:352-796-0324
Practice Address - Fax:352-544-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME15504207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26024Medicare PIN