Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME83365 | FL |
NPI | 1154834489 |
---|---|
Provider Name | Dorothy Richardson |
First Address | Clermont, FL 34711-2936 |
Second Address | Clermont, FL 34711-2936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 08/11/2017 |