Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 44567 | FL |
NPI | 1104585017 |
---|---|
Provider Name | Joan L Richardson |
First Address | Miami, FL 33133-6528 |
Second Address | Miami, FL 33133-6528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2021 |
Last Update Date | 08/12/2021 |