Healthcare Provider Details

I. General information

NPI: 1962403741
Provider Name (Legal Business Name): RICHARD OHERN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 W COCOA BEACH CSWY SUITE 401
COCOA BEACH FL
32931-3577
US

IV. Provider business mailing address

699 W COCOA BEACH CSWY SUITE 401
COCOA BEACH FL
32931-3577
US

V. Phone/Fax

Practice location:
  • Phone: 321-784-5437
  • Fax: 321-799-1231
Mailing address:
  • Phone: 321-784-5437
  • Fax: 321-799-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME25834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: