Basic Information
| Provider Information | |||||||||
| NPI: | 1578524484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIZZUTO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RANDOLPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100275 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522737839 | ||||||||
| FaxNumber: | 3522738172 | ||||||||
| Practice Location | |||||||||
| Address1: | 732 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347484442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522658356 | ||||||||
| FaxNumber: | 3527870854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME95008 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 37068 | 01 | FL | BCBS OF FL | OTHER | 274650600 | 05 | FL | MEDICAID |