Provider Demographics
NPI:1528080926
Name:LI, RICHARD QI (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:QI
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:QI
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1291 SE 65TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-7803
Mailing Address - Country:US
Mailing Address - Phone:941-840-3212
Mailing Address - Fax:
Practice Address - Street 1:2501 SE 49TH AVE.
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480
Practice Address - Country:US
Practice Address - Phone:352-867-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10264OtherBLUECROSS
FL263698102Medicaid
FL10264YMedicare ID - Type Unspecified
FL263698102Medicaid