Provider Demographics
NPI:1609841717
Name:DWOSKIN, RICHARD MARK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:DWOSKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BURNS RD
Mailing Address - Street 2:#208
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4361
Mailing Address - Country:US
Mailing Address - Phone:561-775-1506
Mailing Address - Fax:561-775-7046
Practice Address - Street 1:3375 BURNS RD
Practice Address - Street 2:#208
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4361
Practice Address - Country:US
Practice Address - Phone:561-775-1506
Practice Address - Fax:561-775-7046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041473207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
61337Medicare ID - Type Unspecified
D57198Medicare UPIN