Provider Demographics
NPI:1295798619
Name:LANDRIGAN, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LANDRIGAN
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 1:505 EICHENFELD DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5985
Mailing Address - Country:US
Mailing Address - Phone:813-684-0808
Mailing Address - Fax:813-689-0825
Practice Address - Street 1:505 EICHENFELD DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5985
Practice Address - Country:US
Practice Address - Phone:813-684-0808
Practice Address - Fax:813-689-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM773026Medicaid
NM773026Medicaid
NMD54465Medicare UPIN