Provider Demographics
NPI:1851325112
Name:EDOUARD, PIERRE-RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE-RICHARD
Middle Name:
Last Name:EDOUARD
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 1:16161 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6707
Mailing Address - Country:US
Mailing Address - Phone:305-625-3409
Mailing Address - Fax:305-625-2734
Practice Address - Street 1:16161 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6707
Practice Address - Country:US
Practice Address - Phone:305-625-3409
Practice Address - Fax:305-625-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260320900Medicaid
FLH37575Medicare UPIN
FL260320900Medicaid