MEDICARE: RICHARD MARK DWOSKIN MD

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	207RG0100X	Gastroenterology Physician	ME0041473	FL

General Provider Information

NPI Number	:	1609841717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MARK DWOSKIN MD

Provider Business Mailing Address
First Line	:	3375 BURNS RD
Second Line	:	#208
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4361
Country	:	US
Telephone Number	:	561-775-1506
Fax Number	:	561-775-7046

Provider Business Practice Location Address
First Line	:	3375 BURNS RD
Second Line	:	#208
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4361
Country	:	US
Telephone Number	:	561-775-1506
Fax Number	:	561-775-7046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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