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NPI Code Detail

MEDICARE: MR. CLEVELAND ABBE RICKARDS P.A.

MEDICARE: MR. CLEVELAND ABBE RICKARDS P.A.
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
1363A00000XPhysician Assistant55-0030638VT
2363A00000XPhysician AssistantPA9112293FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831118595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLEVELAND ABBE RICKARDS P.A.
Provider Business Mailing Address
First Line : 1820 58TH AVE STE 110
Second Line :
City : VERO BEACH
State : FL
Zip : 32966-4675
Country : US
Telephone Number : 772-257-3200
Fax Number : 772-257-0187
Provider Business Practice Location Address
First Line : 1820 58TH AVE STE 110
Second Line :
City : VERO BEACH
State : FL
Zip : 32966-4675
Country : US
Telephone Number : 772-257-3200
Fax Number : 772-257-0187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 03/11/2021

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