Provider Demographics
NPI:1336240639
Name:FOLTZ, RICHARD MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:FOLTZ
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 1:3031 NE 55TH LN
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3430
Mailing Address - Country:US
Mailing Address - Phone:954-695-6044
Mailing Address - Fax:
Practice Address - Street 1:3031 NE 55TH LN
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3430
Practice Address - Country:US
Practice Address - Phone:954-695-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067422207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377891600Medicaid
FL377891600Medicaid
FL26985ZMedicare PIN