Healthcare Provider Details

I. General information

NPI: 1528062007
Provider Name (Legal Business Name): RICHARD A CAPUTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HEALTH PARK BLVD STE 214
ST AUGUSTINE FL
32086-5795
US

IV. Provider business mailing address

301 HEALTH PARK BLVD STE 214
ST AUGUSTINE FL
32086-5795
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-0400
  • Fax: 904-829-0411
Mailing address:
  • Phone: 904-829-0400
  • Fax: 904-829-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME26849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: