Provider Demographics
NPI:1902038755
Name:RICHARD J EATROFF M.D, P.A.
Entity type:Organization
Organization Name:RICHARD J EATROFF M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:EATROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-685-5000
Mailing Address - Street 1:510 VONDERBURG DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5980
Mailing Address - Country:US
Mailing Address - Phone:813-685-5000
Mailing Address - Fax:
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5980
Practice Address - Country:US
Practice Address - Phone:813-685-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53866Medicare UPIN