=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598738171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD S DUCKWORTH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 08/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 CATTLEMEN RD SUITE 210
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-371-3337
-----------------------------------------------------
Fax | 941-379-3011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 CATTLEMEN RD SUITE 210
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-371-3337
-----------------------------------------------------
Fax | 941-379-3011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME37092
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------