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General NPI Number Information
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NPI Number | 1215278783
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Entity Type | Individual
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Provider Name | RICHARD OLTON PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 2523 DORA AVE
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City | TAVARES
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State | FL
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Zip | 32778-4977
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Country | US
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Telephone | 352-508-5176
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Fax | 352-508-5179
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Provider Business Mailing Address
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Address Line | 12128 STREAMBED DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-9336
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Country | US
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Telephone | 813-391-6682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106951
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License Number State | FL
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