1285681056 NPI number — VIRGIL HILARN DUVERNAY MD, PHD, FACP

Table of content: VIRGIL HILARN DUVERNAY MD, PHD, FACP (NPI 1285681056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285681056 NPI number — VIRGIL HILARN DUVERNAY MD, PHD, FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUVERNAY
Provider First Name:
VIRGIL
Provider Middle Name:
HILARN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD, FACP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285681056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5040
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95966-0040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-528-5268
Provider Business Mailing Address Fax Number:
918-770-0058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 ORO DAM BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95966-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-712-2171
Provider Business Practice Location Address Fax Number:
530-712-2149
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01063909A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: A45858 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000549587 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 250470 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200870160 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200859330C . This is a "MEDICAID GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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