Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME77946 | FL |
NPI | 1043218977 |
---|---|
Provider Name | Richard G Abood |
First Address | Cincinnati, OH 45263-9321 |
Second Address | Naples, FL 34110-1454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257878600 | (05) | FL |
49272 | BLUE SHIELD (01) | FL |
G61720 | (02) |