Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME34620 | FL |
NPI | 1063415784 |
---|---|
Provider Name | Richard J Hilder JR. |
First Address | Ocala, FL 34474-8468 |
Second Address | Ocala, FL 34474-8468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 26/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F73764 | (02) | FL |
ME34620 | STATE LICENSE (01) | FL |