Provider Demographics
NPI:1295758811
Name:LLERENA, RICHARD L (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:LLERENA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3935
Mailing Address - Country:US
Mailing Address - Phone:941-923-5861
Mailing Address - Fax:941-926-4547
Practice Address - Street 1:6318 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3935
Practice Address - Country:US
Practice Address - Phone:941-923-5861
Practice Address - Fax:941-926-4547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44352DMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER