Provider Demographics
NPI:1881892990
Name:DR RICHARD H BAKST DPM PA
Entity type:Organization
Organization Name:DR RICHARD H BAKST DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAKST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-626-3338
Mailing Address - Street 1:12300 ALT A1A STE 118
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2211
Mailing Address - Country:US
Mailing Address - Phone:561-626-3338
Mailing Address - Fax:561-776-3100
Practice Address - Street 1:12300 ALT A1A STE 118
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2211
Practice Address - Country:US
Practice Address - Phone:561-626-3338
Practice Address - Fax:561-776-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF872Medicare PIN
FLT34363Medicare UPIN
FL4023280001Medicare NSC