MEDICARE: DR. VARAVOOT RAY LERTVARANURAK M.D.

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	2085R0202X	Diagnostic Radiology Physician	A71768	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861478463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VARAVOOT RAY LERTVARANURAK M.D.

Provider Business Mailing Address
First Line	:	827 PACIFIC AVE
Second Line	:	172
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4301
Country	:	US
Telephone Number	:	650-380-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 JACKSON ST
Second Line	:	RADIOLOGY
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4851
Country	:	US
Telephone Number	:	415-677-2320
Fax Number	:

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	03/26/2008

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