Individual
DR. RICHARD LARK DICICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
508 S HABANA AVE, SUITE 160, TAMPA, FL 33609-4181
(813) 877-6000
(813) 877-6002
Mailing address
37840 MEDICAL ARTS CT, ZEPHYRHILLS, FL 33541-4325
(813) 788-5569
(813) 782-8628
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME90737
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
307206
AMERIGROUP
FL
01
—
50968
BLUE CROSS BLUE SHIELD FL
FL
01
—
7683574
AETNA HEALTHCARE
FL
Enumeration date
08/16/2005
Last updated
01/14/2022
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