MEDICARE: DR. RICHARD JAMES DOVIAK II 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
1	207L00000X	Anesthesiology Physician	ME80523	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03817	OTHER	FL	BCBS ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2939612	OTHER	FL	AETNA INS. ID#
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811993777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JAMES DOVIAK II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91713
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-1713
Country	:	US
Telephone Number	:	352-867-8898
Fax Number	:	352-732-6282

Provider Business Practice Location Address
First Line	:	3340 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-1974
Country	:	US
Telephone Number	:	352-867-8898
Fax Number	:	352-732-6282

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/27/2009

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