Provider Demographics
NPI:1386971034
Name:PHARES, RICHARD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
Last Name:PHARES
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 1:2299 9TH AVE N
Mailing Address - Street 2:2-C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6800
Mailing Address - Country:US
Mailing Address - Phone:727-328-2299
Mailing Address - Fax:727-327-1404
Practice Address - Street 1:2299 9TH AVE N
Practice Address - Street 2:2-C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6800
Practice Address - Country:US
Practice Address - Phone:727-328-2299
Practice Address - Fax:727-327-1404
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist