MEDICARE: JOEL D OREVILLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	10862	NV

General Provider Information

NPI Number	:	1265476774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL D OREVILLO MD

Provider Business Mailing Address
First Line	:	PO BOX 81345
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-1345
Country	:	US
Telephone Number	:	702-384-5101
Fax Number	:	702-382-5675

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0466
Country	:	US
Telephone Number	:	702-387-5101
Fax Number	:	702-382-5675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/12/2019

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