Healthcare Provider Details

I. General information

NPI: 1265793020
Provider Name (Legal Business Name): RICHARD ORAVEC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 W HERNDON AVE STE 105
FRESNO CA
93722-8401
US

IV. Provider business mailing address

4770 W HERNDON AVE STE 105
FRESNO CA
93722-8401
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-2663
  • Fax: 559-450-2724
Mailing address:
  • Phone: 559-450-2663
  • Fax: 559-450-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD455817
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT200938
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA156769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: