Healthcare Provider Details

I. General information

NPI: 1710046776
Provider Name (Legal Business Name): RICHARD L DIAMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 PORTOFINO DR
NORTH VENICE FL
34275-6654
US

IV. Provider business mailing address

269 PORTOFINO DR
NORTH VENICE FL
34275-6654
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-8315
  • Fax: 941-485-8523
Mailing address:
  • Phone: 941-485-8315
  • Fax: 941-485-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: