Provider Demographics
NPI:1740292069
Name:KLEIN, RICHARD DAVID (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:KLEIN
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 1:265 E ROLLINS ST STE 5300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5519
Mailing Address - Country:US
Mailing Address - Phone:074-821-3555
Mailing Address - Fax:407-821-3556
Practice Address - Street 1:265 E ROLLINS ST STE 5300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5519
Practice Address - Country:US
Practice Address - Phone:074-821-3555
Practice Address - Fax:407-821-3556
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME932012086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16049OtherBLUE CROSS BLUE SHIELD
FL272517700Medicaid
FLME93201OtherMEDICAL LICENSE
FLG56352Medicare UPIN
FL16049OtherBLUE CROSS BLUE SHIELD
FLP00400512Medicare PIN