Provider Demographics
NPI:1831208503
Name:RICHMAN, LAURENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 OUTER RD STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6688
Mailing Address - Country:US
Mailing Address - Phone:407-228-2838
Mailing Address - Fax:407-894-5151
Practice Address - Street 1:899 OUTER RD STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6688
Practice Address - Country:US
Practice Address - Phone:407-228-2838
Practice Address - Fax:407-894-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0000443213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052080200Medicaid
FL87195Medicare PIN
FL052080200Medicaid
FL3988240001Medicare NSC
FLU20642Medicare UPIN