Provider Demographics
NPI:1194726091
Name:WAKS, RICK (DO)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:WAKS
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-217-7469
Practice Address - Street 1:13691 METRO PKWY STE 130
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4321
Practice Address - Country:US
Practice Address - Phone:239-349-3539
Practice Address - Fax:239-217-7469
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266452600Medicaid
FLP0000556Medicare PIN
FL57635ZMedicare PIN