Basic Information
| Provider Information | |||||||||
| NPI: | 1194711713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOLLWELL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | OSWALD | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349950417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722232832 | ||||||||
| FaxNumber: | 7722235646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 SE OCEAN BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349963341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722194026 | ||||||||
| FaxNumber: | 7722834919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2000153636 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | OS11914 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 014114300 | 05 | FL | MEDICAID | 208357301 | 05 | MO | MEDICAID | 2114206 | 01 | MO | FIRST HEALTH/CNN | OTHER | 17007 | 01 | MO | GHP | OTHER | P00009295 | 01 | MO | RAILROAD MEDICARE | OTHER | 17-01150 | 01 | MO | UNITED HEALTHCARE | OTHER | 179066 | 01 | MO | BLUECROSS/BLUESHIELD | OTHER | 546711 | 01 | MO | HEALTHLINK | OTHER | 76-0728896 | 01 | MO | PRIVATE HEALTHCARE SYSTEM | OTHER |