MEDICARE: GARY J RICHMOND,MD,PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467466466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY J RICHMOND,MD,PA

Provider Business Mailing Address
First Line	:	315 SE 14TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1929
Country	:	US
Telephone Number	:	954-524-2250
Fax Number	:	954-524-5833

Provider Business Practice Location Address
First Line	:	315 SE 14TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1929
Country	:	US
Telephone Number	:	954-524-2250
Fax Number	:	954-524-5833

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY J RICHMOND
Credential	:	MD
Telephone Number	:	954-524-2250

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	12/04/2009

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