Provider Demographics
NPI:1649271917
Name:PICERNO, RICHARD A II (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:PICERNO
Suffix:II
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 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-880-1210
Practice Address - Street 1:14534 OLD SAINT AUGUSTINE RD STE 3220
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2645
Practice Address - Country:US
Practice Address - Phone:904-880-1260
Practice Address - Fax:904-880-1210
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93510207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273545800Medicaid
FLP00251780OtherRR MEDICARE
FL273545800Medicaid
FL16374WMedicare PIN
FL16374ZMedicare PIN
FLP00251780OtherRR MEDICARE
FL16374XMedicare PIN