Basic Information
Provider Information | |||||||||
NPI: | 1053387191 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DE ASLA | ||||||||
FirstName: | RICHARD | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1285 CREEKSIDE BLVD E | ||||||||
Address2: | SUITE 102 | ||||||||
City: | NAPLES | ||||||||
State: | FL | ||||||||
PostalCode: | 341090590 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2396240310 | ||||||||
FaxNumber: | 2396240311 | ||||||||
Practice Location | |||||||||
Address1: | 1285 CREEKSIDE BLVD EAST | ||||||||
Address2: | SUITE 102 | ||||||||
City: | NAPLES | ||||||||
State: | FL | ||||||||
PostalCode: | 34109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2396240310 | ||||||||
FaxNumber: | 2396240311 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/28/2006 | ||||||||
LastUpdateDate: | 04/10/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME124827 | FL | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XX0004X | ME124827 | FL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | 469901 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 151P9 | 01 | FL | BCBS | OTHER | J28081 | 01 | MA | BCBS MA | OTHER | 015525100 | 05 | FL |   | MEDICAID |