Healthcare Provider Details

I. General information

NPI: 1417057647
Provider Name (Legal Business Name): RICHARD A. DEVORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 CORNELL RD STE 410
CINCINNATI OH
45249-2235
US

IV. Provider business mailing address

PO BOX 632603
CINCINNATI OH
45263-0027
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-6757
  • Fax: 513-792-8035
Mailing address:
  • Phone: 513-891-2813
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD A DEVORE
Title or Position: OWNER
Credential: MD
Phone: 513-791-6757