Basic Information
| Provider Information | |||||||||
| NPI: | 1730436205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIERRE-RICHARD EDOUARD M D PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16161 NW 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330146707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056253409 | ||||||||
| FaxNumber: | 3056252734 | ||||||||
| Practice Location | |||||||||
| Address1: | 16161 NW 57TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330146707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056253409 | ||||||||
| FaxNumber: | 3056252734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2012 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | EDOUARD | ||||||||
| AuthorizedOfficialFirstName: | PIERRE-RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056253409 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.