Provider Demographics
NPI:1477510402
Name:RANDALL P. RICHE MDPA
Entity type:Organization
Organization Name:RANDALL P. RICHE MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RICHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-432-9698
Mailing Address - Street 1:4700 BAYOU BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2670
Mailing Address - Country:US
Mailing Address - Phone:850-478-1312
Mailing Address - Fax:850-432-9453
Practice Address - Street 1:4700 BAYOU BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2670
Practice Address - Country:US
Practice Address - Phone:850-432-9698
Practice Address - Fax:850-432-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59729174400000X
207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259118900Medicaid
FL259118900Medicaid