Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OS0005899F | FL |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS0005899 | FL |
N | 207Q00000X | Family Doctor | OS0005899 | FL |
NPI | 1184698128 |
---|---|
Provider Name | Dr. Richard Longwill Vanbuskirk |
First Address | Sarasota, FL 34239-5133 |
Second Address | Sarasota, FL 34239-5133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E617996 | (02) | FL |