Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME57276 | FL |
NPI | 1013936335 |
---|---|
Provider Name | Dr. Richard Harrison |
First Address | Wellington, FL 33414-9009 |
Second Address | Riviera Beach, FL 33410-7417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VADOO | (02) | FL |