Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME24108 | FL |
NPI | 1295062438 |
---|---|
Provider Name | Dr. Richard Martin Nazareth |
First Address | South Miami, FL 33143-3205 |
Second Address | South Miami, FL 33143-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2009 |
Last Update Date | 09/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME24108 | NONE (01) | FL |