Provider Demographics
NPI:1285824664
Name:RICHARD PLEVA
Entity Type:Organization
Organization Name:RICHARD PLEVA
Other - Org Name:DIGESTIVE DISEASE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-4066
Mailing Address - Street 1:PO BOX 11654
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1654
Mailing Address - Country:US
Mailing Address - Phone:928-445-4066
Mailing Address - Fax:928-445-4345
Practice Address - Street 1:5350 DISTINCTION WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8418
Practice Address - Country:US
Practice Address - Phone:928-445-4066
Practice Address - Fax:928-445-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z74426Medicare PIN