Provider Demographics
NPI:1528172939
Name:FANSLER, RICHARD F (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:FANSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11200 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3259
Mailing Address - Country:US
Mailing Address - Phone:727-584-9500
Mailing Address - Fax:727-393-9502
Practice Address - Street 1:12955 SEMINOLE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2399
Practice Address - Country:US
Practice Address - Phone:727-584-9500
Practice Address - Fax:727-393-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME67619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378268900Medicaid
FL378268900Medicaid
FLF57549Medicare UPIN