Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN 7401 | FL |
NPI | 1568493187 |
---|---|
Provider Name | Dr. Harley Mercer Richards |
First Address | Lakeland, FL 33803-5917 |
Second Address | Lakeland, FL 33803-5917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |