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  5. RICHARD LAWRENCE SIEGEL, M.D., P.A.

RICHARD LAWRENCE SIEGEL, M.D., P.A.

Company Details

Entity Name: RICHARD LAWRENCE SIEGEL, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 16 Dec 1983 (41 years ago)
Document Number: G75634
FEI/EIN Number 592422927
Address: 17407 Bridge Hill Ct, TAMPA, FL, 33647, US
Mail Address: 16002 Langhorne Ct, TAMPA, FL, 33647, US
ZIP code: 33647
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255639886 2011-03-07 2011-06-15 3450 EAST FLETCHER AVENUE, SUITE 210, TAMPA, FL, 336134655, US 3450 EAST FLETCHER AVENUE, SUITE 210, TAMPA, FL, 336134655, US

Contacts
Phone +1 813-972-3131
Fax 6139720773

Authorized person
Name DR. RICHARD LAWRENCE SIEGEL
Role OWNER/PRESIDENT
Phone 8139723131

Taxonomy
Taxonomy Code 207K00000X - Allergy & Immunology Physician
License Number ME37894
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 065518000
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2023 592422927 2024-11-13 RICHARD LAWRENCE SIEGEL, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2022 592422927 2023-07-12 RICHARD LAWRENCE SIEGEL, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2021 592422927 2022-10-15 RICHARD LAWRENCE SIEGEL, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2020 592422927 2021-10-06 RICHARD LAWRENCE SIEGEL, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2019 592422927 2020-10-14 RICHARD LAWRENCE SIEGEL, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2018 592422927 2019-10-07 RICHARD LAWRENCE SIEGEL, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2017 592422927 2018-10-02 RICHARD LAWRENCE SIEGEL, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 17407 BRIDGE HILL COURT, SUITE B, TAMPA, FL, 33647
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2016 592422927 2017-11-16 RICHARD LAWRENCE SIEGEL, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 3450 E. FLETCHER AVE, SUITE 210, TAMPA, FL, 336134600
RICHARD LAWRENCE SIEGEL, M. D. , P. A. CASH BALANCE PLAN 2015 592422927 2016-09-30 RICHARD LAWRENCE SIEGEL, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 3450 E. FLETCHER AVE, SUITE 210, TAMPA, FL, 336134600

Signature of
Role Plan administrator
Date 2016-09-30
Name of individual signing AUSTIN COLLINS
Valid signature Filed with authorized/valid electronic signature
RICHARD LAWRENCE SIEGEL, M. D. , P. A. PROFIT SHARING PLAN 2015 592422927 2016-09-30 RICHARD LAWRENCE SIEGEL, M. D. , P. A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8139723131
Plan sponsor’s address 3450 E. FLETCHER AVENUE, SUITE 210, TAMPA, FL, 336134600

Signature of
Role Plan administrator
Date 2016-09-30
Name of individual signing PAUL GALBRAITH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SIEGEL,RICHARD L Agent 16002 LANGHORNE COURT, TAMPA, FL, 33647

President

Name Role Address
SIEGEL RICHARD L President 16002 LANGHORNE COURT, TAMPA, FL, 33647

Secretary

Name Role Address
Siegel Tracey W Secretary 16002 Langhorne Court, TAMPA, FL, 33647

Related by officers

No related officers

Related by address

17407 Bridge Hill Ct, TAMPA, FL, 33647, US

LIBERTY GARDENS MHC, LLC LCG PARK MANAGEMENT LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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