Provider Demographics
NPI:1962403741
Name:OHERN, RICHARD (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:OHERN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W COCOA BEACH CSWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3577
Mailing Address - Country:US
Mailing Address - Phone:321-784-5437
Mailing Address - Fax:321-799-1231
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:SUITE 401
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3577
Practice Address - Country:US
Practice Address - Phone:321-784-5437
Practice Address - Fax:321-799-1231
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics