Provider Demographics
NPI:1215933189
Name:PRICE, RICHARD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:PRICE
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 1:3365 BURNS RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4303
Mailing Address - Country:US
Mailing Address - Phone:561-626-5606
Mailing Address - Fax:561-626-6376
Practice Address - Street 1:3365 BURNS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4303
Practice Address - Country:US
Practice Address - Phone:561-626-5606
Practice Address - Fax:561-626-6376
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040185207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370204900Medicaid
FL370204900Medicaid
FL96128Medicare ID - Type Unspecified