MEDICARE: RICHARD A PICERNO II M.D.

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME93510	FL
2	207X00000X	Orthopaedic Surgery Physician	ME93510	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00251780	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649271917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A PICERNO II M.D.

Provider Business Mailing Address
First Line	:	1325 SAN MARCO BLVD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8568
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-880-1210

Provider Business Practice Location Address
First Line	:	14534 OLD SAINT AUGUSTINE RD STE 3220
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2645
Country	:	US
Telephone Number	:	904-880-1260
Fax Number	:	904-880-1210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/17/2020

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Directions to “ RICHARD A PICERNO II M.D.” Practice Location

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