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General NPI Number Information
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NPI Number | 1508004235
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Entity Type | Organization
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Legal Business Name | RICHARD L VAN BUSKIRK D O P A
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 2900 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34239-5133
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Country | US
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Telephone | 941-924-1729
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Fax | 941-927-9375
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Provider Business Mailing Address
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Address Line | 2900 S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34239-5133
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Country | US
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Telephone | 941-924-1729
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Fax | 941-927-9375
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. RICHARD LONGWILL VAN BUSKIRK
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Credential | D.O.
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Telephone | 941-924-1729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | OS0005899
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License Number State | FL
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