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General NPI Number Information
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NPI Number | 1487630851
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Entity Type | Individual
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Provider Name | LAWRENCE ADAM RIESZ MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 1600 S ANDREWS AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-2510
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Country | US
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Telephone | 954-355-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 12200 NW 77TH MNR
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City | PARKLAND
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State | FL
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Zip | 33076-4511
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Country | US
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Telephone | 954-346-3482
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 042718
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME96288
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License Number State | FL
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