Provider Demographics
NPI:1124056932
Name:ISAACSON, RICHARD S (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GLADES ROAD
Mailing Address - Street 2:OFFICE BUILDING 1 FIRST FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-0000
Mailing Address - Country:US
Mailing Address - Phone:561-297-0372
Mailing Address - Fax:
Practice Address - Street 1:777 GLADES RD
Practice Address - Street 2:OFFICE BUILDING 1 FIRST FLOOR
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-297-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME935492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273118500Medicaid
FLU55792Medicare UPIN
I38337Medicare UPIN