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NPI Code Detail

MEDICARE: RICHARD A. LILES M.D.

MEDICARE: RICHARD A. LILES M.D.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianME0056281FL

General Provider Information

NPI Number : 1740259621
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD A. LILES M.D.
Provider Business Mailing Address
First Line : 901 CLEARWATER LARGO RD N
Second Line :
City : LARGO
State : FL
Zip : 33770-4126
Country : US
Telephone Number : 727-584-4533
Fax Number : 727-581-7386
Provider Business Practice Location Address
First Line : 901 CLEARWATER LARGO RD N
Second Line :
City : LARGO
State : FL
Zip : 33770-4126
Country : US
Telephone Number : 727-584-4533
Fax Number : 727-581-7386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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