Healthcare Provider Details

I. General information

NPI: 1821099516
Provider Name (Legal Business Name): RANDALL PAUL RICHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BAYOU BLVD STE 1B
PENSACOLA FL
32503-2670
US

IV. Provider business mailing address

4700 BAYOU BLVD STE 1B
PENSACOLA FL
32503-2670
US

V. Phone/Fax

Practice location:
  • Phone: 850-432-9698
  • Fax: 850-432-9453
Mailing address:
  • Phone: 850-432-9698
  • Fax: 850-432-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME59729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: