Healthcare Provider Details

I. General information

NPI: 1902992530
Provider Name (Legal Business Name): RICHARD H CIORDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 NORTH DAVIS HIGHWAY
PENSACOLA FL
32503
US

IV. Provider business mailing address

4900 BAYOU BOULEVARD SUITE 111
PENSACOLA FL
32503
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8988
  • Fax: 850-476-5312
Mailing address:
  • Phone: 850-477-8109
  • Fax: 850-478-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME20564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: