Provider Demographics
NPI:1760643282
Name:RICHARDS, MARC SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:SPENCER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1905 CLINT MOORE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:561-989-9070
Mailing Address - Fax:561-989-0255
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-989-9070
Practice Address - Fax:561-989-0255
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2020-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL317034207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86503UMedicare UPIN