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General NPI Number Information
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NPI Number | 1285824664
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Entity Type | Organization
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Legal Business Name | RICHARD PLEVA
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 5350 DISTINCTION WAY
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City | PRESCOTT
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State | AZ
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Zip | 86301-8418
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Country | US
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Telephone | 928-445-4066
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Fax | 928-445-4345
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Provider Business Mailing Address
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Address Line | PO BOX 11654
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City | PRESCOTT
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State | AZ
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Zip | 86304-1654
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Country | US
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Telephone | 928-445-4066
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Fax | 928-445-4345
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD PLEVA
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Credential | MD
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Telephone | 928-445-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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