Provider Demographics
NPI:1699796961
Name:EGERMAN, RICHARD JON (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JON
Last Name:EGERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13489 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1347
Mailing Address - Country:US
Mailing Address - Phone:561-495-9700
Mailing Address - Fax:561-496-5588
Practice Address - Street 1:13489 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1347
Practice Address - Country:US
Practice Address - Phone:561-495-9700
Practice Address - Fax:561-496-5588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001773213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390401600Medicaid
T51266Medicare UPIN
FL65534ZMedicare PIN