MEDICARE: RDR SERVICES, LLC

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	363AS0400X	Surgical Physician Assistant	3599	FL

General Provider Information

NPI Number	:	1669638904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RDR SERVICES, LLC

Provider Business Mailing Address
First Line	:	4316 PASADENA CIR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3623
Country	:	US
Telephone Number	:	941-923-7318
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 PASADENA CIR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3623
Country	:	US
Telephone Number	:	941-923-7318
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING MANAGER
Name	:	MR. ROBERT DOUGLAS RUNK
Credential	:	PA-C
Telephone Number	:	941-923-7318

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	07/01/2011

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