Provider Demographics
NPI:1760935886
Name:RICHARDS, JEFFREY S
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 COLLINS AVE
Mailing Address - Street 2:UNIT #1411
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3263
Mailing Address - Country:US
Mailing Address - Phone:786-859-2254
Mailing Address - Fax:
Practice Address - Street 1:6917 COLLINS AVE
Practice Address - Street 2:UNIT #1411
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3263
Practice Address - Country:US
Practice Address - Phone:786-859-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA6017OtherDEPARTMENT OF HEALTH