Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN5747 | FL |
NPI | 1144210964 |
---|---|
Provider Name | Dr. Richard Wayne Joseph SR. |
First Address | Jacksonville, FL 32256 |
Second Address | Jacksonville, FL 32256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U02606 | (02) |