Provider Demographics
NPI:1073856308
Name:FIELDS, RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 COCONUT CREEK PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1634
Mailing Address - Country:US
Mailing Address - Phone:954-330-6044
Mailing Address - Fax:786-513-8481
Practice Address - Street 1:3720 COCONUT CREEK PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1634
Practice Address - Country:US
Practice Address - Phone:954-330-6044
Practice Address - Fax:786-513-8481
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3657213ES0103X
NY65 006558213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU 515AMedicare UPIN