MEDICARE: JEFFREY S. RICHARDS

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	174400000X	Specialist	MA60617	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA6017	OTHER	FL	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1760935886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY S. RICHARDS

Provider Business Mailing Address
First Line	:	6917 COLLINS AVE
Second Line	:	UNIT #1411
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3263
Country	:	US
Telephone Number	:	786-859-2254
Fax Number	:

Provider Business Practice Location Address
First Line	:	6917 COLLINS AVE
Second Line	:	UNIT #1411
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3263
Country	:	US
Telephone Number	:	786-859-2254
Fax Number	:

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

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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