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NPI Code Detail

MEDICARE: SAMUEL T RICHBOURG M.D.

MEDICARE: SAMUEL T RICHBOURG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianME41914FL
22085R0202XDiagnostic Radiology Physician58473KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2300118096OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
347537OTHERFLBCBS OF FLORIDA

General Provider Information

NPI Number : 1174520134
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL T RICHBOURG M.D.
Provider Business Mailing Address
First Line : PO BOX 150505
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32715-0505
Country : US
Telephone Number : 407-767-0433
Fax Number : 407-767-0608
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-1944
Fax Number : 407-303-1746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 12/31/2025

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