Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | ME15397 | FL |
NPI | 1699718072 |
---|---|
Provider Name | Dr. George A Richard |
First Address | Orlando, FL 32891-8025 |
Second Address | Gainesville, FL 32610-0371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50221 | (02) |