Individual
RICHARD KLEMENTAVICIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
617 BAY CLIFFS RD, GULF BREEZE, FL 32561-4805
(850) 934-4107
(850) 934-4107
Mailing address
617 BAY CLIFFS RD, GULF BREEZE, FL 32561-4805
(850) 934-4107
(850) 934-4107
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME77791
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009984555
—
AL
05
—
256621400
—
FL
01
—
46336
BCBS
FL
01
—
59169917
BCBS
AL
01
—
P00134526
PALMETTO GBA-RR MEDICARE
—
Enumeration date
05/17/2006
Last updated
11/02/2010
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