Provider Demographics
NPI:1265476774
Name:OREVILLO, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:OREVILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 81345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-1345
Mailing Address - Country:US
Mailing Address - Phone:702-384-5101
Mailing Address - Fax:702-382-5675
Practice Address - Street 1:7200 CATHEDRAL ROCK DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0466
Practice Address - Country:US
Practice Address - Phone:702-387-5101
Practice Address - Fax:702-382-5675
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10862207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504376Medicaid
NVH72121Medicare UPIN
NV40156Medicare PIN