Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 35049692R | OH |
Y | 207QA0505X | Family Doctor - Adult Medicine | ME0040204 | FL |
NPI | 1144293226 |
---|---|
Provider Name | Mr. Richard Michael Roistacher |
First Address | Sunrise, FL 33351-7307 |
Second Address | Sunrise, FL 33351-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D58912 | (02) |