MEDICARE: DR. RICHARD ALLEN HILL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS6639	FL

General Provider Information

NPI Number	:	1205160215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALLEN HILL D.O.

Provider Business Mailing Address
First Line	:	1318 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-657-3983
Fax Number	:	954-636-4105

Provider Business Practice Location Address
First Line	:	1318 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-657-3983
Fax Number	:	954-636-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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