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General NPI Number Information
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NPI Number | 1295711968
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Entity Type | Individual
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Provider Name | COSIMO A RICCIARDI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 341A RACETRACK RD NW STE A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1552
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Country | US
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Telephone | 850-862-4119
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Fax | 850-862-5470
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Provider Business Mailing Address
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Address Line | 120 E REDSTONE AVE STE A
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City | CRESTVIEW
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State | FL
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Zip | 32539-5370
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Country | US
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Telephone | 850-862-4119
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Fax | 850-862-5470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2964
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License Number State | FL
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