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NPI Code Detail

MEDICARE: DR. RICHARD KRUBEL MD

MEDICARE: DR. RICHARD KRUBEL MD
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
1207P00000XEmergency Medicine PhysicianME92207FL
2207Q00000XFamily Medicine PhysicianME92207FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101552OTHERFLBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619979853
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD KRUBEL MD
Provider Business Mailing Address
First Line : 250 HARRISON STREET
Second Line : PHN OFFICE
City : TITUSVILLE
State : FL
Zip : 32780
Country : US
Telephone Number : 321-268-6868
Fax Number : 321-267-2713
Provider Business Practice Location Address
First Line : 250 HARRISON ST
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-5094
Country : US
Telephone Number : 321-268-6868
Fax Number : 321-267-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 10/02/2020

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