Provider Demographics
NPI:1952381923
Name:STACHLER, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:STACHLER
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 1:1118 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7800
Mailing Address - Country:US
Mailing Address - Phone:850-934-5777
Mailing Address - Fax:
Practice Address - Street 1:1118 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7800
Practice Address - Country:US
Practice Address - Phone:850-934-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056407900Medicaid
FL14242OtherBLUE CROSS BLUE SHIELD FL
AL59167052OtherBLUE CROSS BLUE SHIELD AL
FLA124OtherHEALTH FIRST NETWORK
FL110231746OtherRAILROAD MEDICARE
FL14242WMedicare PIN
FLA124OtherHEALTH FIRST NETWORK