=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033301403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD LLOYD SPEICHER II PA C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2007
-----------------------------------------------------
Last Update Date | 10/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2575 S VOLUSIA AVE SUITE 300
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-9135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-774-0401
-----------------------------------------------------
Fax | 386-774-5783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2555 S VOLUSIA AVE
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-9116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-774-0401
-----------------------------------------------------
Fax | 386-774-5783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA0002394
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------