Provider Demographics
NPI:1972799534
Name:RICHARD D CURTIS M.D., P.A.
Entity type:Organization
Organization Name:RICHARD D CURTIS M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-215-2422
Mailing Address - Street 1:1715 EAGLE HARBOR PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4323
Mailing Address - Country:US
Mailing Address - Phone:904-215-2422
Mailing Address - Fax:904-215-6122
Practice Address - Street 1:1715 EAGLE HARBOR PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4323
Practice Address - Country:US
Practice Address - Phone:904-215-2422
Practice Address - Fax:904-215-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86051174400000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001701100Medicaid
H74336Medicare UPIN
K6902Medicare PIN
FL001701100Medicaid
6340150001Medicare NSC