Individual
CHARLES HARRY RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1528 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1036
(954) 467-8855
(954) 467-8857
Mailing address
1528 NE 4TH AVE, FORT LAUDERDALE, FL 33304-1036
(954) 467-8855
(954) 467-8857
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS8590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268453500
—
FL
Enumeration date
08/10/2006
Last updated
09/28/2012
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