Provider Demographics
NPI:1295062438
Name:NAZARETH, RICHARD MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:NAZARETH
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 1:6633 SW 64TH CT
Mailing Address - Street 2:NONE
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3205
Mailing Address - Country:US
Mailing Address - Phone:321-439-3066
Mailing Address - Fax:305-740-9246
Practice Address - Street 1:6633 SW 64TH CT
Practice Address - Street 2:NONE
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3205
Practice Address - Country:US
Practice Address - Phone:321-439-3066
Practice Address - Fax:305-740-9246
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME241082086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME24108OtherNONE