Provider Demographics
NPI:1972983872
Name:RICHARD CHERN MD, LLC
Entity type:Organization
Organization Name:RICHARD CHERN MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-830-3012
Mailing Address - Street 1:12889 EMERALD COAST PKWY W
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3243
Mailing Address - Country:US
Mailing Address - Phone:850-837-1271
Mailing Address - Fax:
Practice Address - Street 1:12889 EMERALD COAST PKWY W
Practice Address - Street 2:SUITE 107B
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3243
Practice Address - Country:US
Practice Address - Phone:850-837-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95148261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care