Provider Demographics
NPI:1992051809
Name:RICHMAN, MARC ALEN (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALEN
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-0340
Mailing Address - Country:US
Mailing Address - Phone:727-729-2975
Mailing Address - Fax:727-614-9428
Practice Address - Street 1:12464 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3005
Practice Address - Country:US
Practice Address - Phone:727-729-2975
Practice Address - Fax:727-614-9428
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4529207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery