Provider Demographics
NPI:1528062007
Name:CAPUTO, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:CAPUTO
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 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:STE 214
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5795
Mailing Address - Country:US
Mailing Address - Phone:904-829-0400
Mailing Address - Fax:904-829-0411
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:STE 214
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5795
Practice Address - Country:US
Practice Address - Phone:904-829-0400
Practice Address - Fax:904-829-0411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26849207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE11918Medicare UPIN
FL18018Medicare ID - Type UnspecifiedPROVIDER NUMBER