Basic Information
| Provider Information | |||||||||
| NPI: | 1003804832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHTER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7926 W HILLSBOROUGH AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138869180 | ||||||||
| FaxNumber: | 8138889093 | ||||||||
| Practice Location | |||||||||
| Address1: | 7926 W HILLSBOROUGH AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138869180 | ||||||||
| FaxNumber: | 8138889093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | PO1517 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | PO OOO1517 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 104003200 | 05 | FL | MEDICAID | 480002605 | 01 | FL | RAILROAD MEDICARE | OTHER |