Provider Demographics
NPI:1194711713
Name:FOLLWELL, RICHARD OSWALD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:OSWALD
Last Name:FOLLWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:2221 SE OCEAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3341
Practice Address - Country:US
Practice Address - Phone:772-219-4026
Practice Address - Fax:772-283-4919
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000153636208600000X
FLOS11914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014114300Medicaid
MO208357301Medicaid
MO2114206OtherFIRST HEALTH/CNN
MO17007OtherGHP
MOP00009295OtherRAILROAD MEDICARE
MO17-01150OtherUNITED HEALTHCARE
MO179066OtherBLUECROSS/BLUESHIELD
MO546711OtherHEALTHLINK
MO76-0728896OtherPRIVATE HEALTHCARE SYSTEM
MO2114206OtherFIRST HEALTH/CNN
FL014114300Medicaid
MO001014020Medicare PIN
MOP00009295OtherRAILROAD MEDICARE