Doctor Name: | DR. RICHARD JOHN WACLAWSKI |
NPI Number: | 1568429306 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 23560 |
Business Practice Address: | 340 Hulse Rd Pensacola, FL - 325081089 |
Business Phone Number: | 8504522458 |
Business Fax Number: | |
Mailing Address: | 4350 Rawhide Way, OCEANSIDE |
State: | CA |
Postal Code: | 920576507 |
Phone Number: | 7609676459 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 23560 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |