=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730552720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY RISO MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2015
-----------------------------------------------------
Last Update Date | 01/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 771 NE 33RD ST
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-485-5666
-----------------------------------------------------
Fax | 954-510-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 771 NE 33RD ST
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-485-5666
-----------------------------------------------------
Fax | 954-510-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANTHONY RISO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-944-3150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0045338
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------