Provider Demographics
NPI:1144375684
Name:GINGRAS, RICHARD RODRIGUE (CPO)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RODRIGUE
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28025 EAGLE RAY CT
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8402
Mailing Address - Country:US
Mailing Address - Phone:336-414-5828
Mailing Address - Fax:
Practice Address - Street 1:90 CYPRESS WAY E
Practice Address - Street 2:STE 60
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-307-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795001Medicaid