Healthcare Provider Details

I. General information

NPI: 1922029438
Provider Name (Legal Business Name): RICHARD EUGENE LUDWIG PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 CORTEZ BLVD
SPRING HILL FL
34613-5409
US

IV. Provider business mailing address

353 ROYAL PALM WAY
SPRING HILL FL
34608-9427
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-3008
  • Fax: 352-597-3024
Mailing address:
  • Phone: 407-370-2740
  • Fax: 727-507-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: