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General NPI Number Information
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NPI Number | 1851382246
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Entity Type | Individual
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Provider Name | BERNARD LOUIS FIORAVANTI MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 1510 W 90TH ST N
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City | WAGONER
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State | OK
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Zip | 74467-8159
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Country | US
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Telephone | 918-519-1155
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Fax | 918-683-4416
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Provider Business Mailing Address
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Address Line | 1510 W 90TH ST N
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City | WAGONER
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State | OK
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Zip | 74467-8159
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Country | US
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Telephone | 918-686-5552
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Fax | 918-683-4416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11797
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License Number State | OK
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