Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 65 006558 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | PO 3657 | FL |
NPI | 1073856308 |
---|---|
Provider Name | Dr. Richard Fields |
First Address | Coconut Creek, FL 33066-1634 |
Second Address | Coconut Creek, FL 33066-1634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 20/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HU 515A | (02) | FL |