Provider Demographics
NPI:1295767390
Name:VANELDIK, RICHARD B (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:VANELDIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1901 SE 18TH AVE
Mailing Address - Street 2:BUILDING # 400
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-732-8905
Mailing Address - Fax:352-732-2440
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:BUILDING # 400
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-732-8905
Practice Address - Fax:352-732-2440
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44848207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046664600Medicaid
FL42200Medicare ID - Type Unspecified
FLC36469Medicare UPIN