Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME0033511 | FL |
NPI | 1013974435 |
---|---|
Provider Name | Richard A Chazal |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041820000 | (05) | FL |
D54489 | (02) |