Individual
MR. ROBERT W SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1380 ROANOKE AVE, RIVERHEAD, NY 11901-2098
(631) 369-0022
(631) 369-5336
Mailing address
1380 ROANOKE AVE, RIVERHEAD, NY 11901-2098
(631) 369-0022
(631) 369-5336
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400418
NY
Other
Enumeration date
09/29/2006
Last updated
12/10/2010
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