MEDICARE: DR. DANA PHILLIP RICHARD D.O.

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
1	207Q00000X	Family Medicine Physician	OS5435	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80230	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528041068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA PHILLIP RICHARD D.O.

Provider Business Mailing Address
First Line	:	309 E OCEAN AVE APT 103
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3265
Country	:	US
Telephone Number	:	561-434-5678
Fax Number	:	786-221-4352

Provider Business Practice Location Address
First Line	:	2500 METROCENTRE BLVD
Second Line	:	SUITE 7
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3107
Country	:	US
Telephone Number	:	561-434-5678
Fax Number	:	561-964-9829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/26/2018

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