MEDICARE: HENRY J RICHTER MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME37512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59906	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528174869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY J RICHTER MD PA

Provider Business Mailing Address
First Line	:	PO BOX 1448
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32727-1448
Country	:	US
Telephone Number	:	352-735-0068
Fax Number	:	352-735-0305

Provider Business Practice Location Address
First Line	:	1502 N DONNELLY ST
Second Line	:	SUITE 110
City	:	MT DORA
State	:	FL
Zip	:	32757-2846
Country	:	US
Telephone Number	:	352-735-0068
Fax Number	:	352-735-0305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY JAMES RICHTER
Credential	:	MD
Telephone Number	:	352-735-0068

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/16/2009

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