Provider Demographics
NPI:1376554709
Name:CERNA, ORVILLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:ORVILLE
Middle Name:D
Last Name:CERNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ORVILLE
Other - Middle Name:DIAZ
Other - Last Name:CERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1010 S EDDY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-3709
Mailing Address - Country:US
Mailing Address - Phone:432-447-2030
Mailing Address - Fax:432-447-7347
Practice Address - Street 1:1010 S EDDY ST UNIT B
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-3709
Practice Address - Country:US
Practice Address - Phone:432-447-2030
Practice Address - Fax:432-447-7347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123260503Medicaid
TX123260503Medicaid
00H24TMedicare Oscar/Certification
A29625Medicare UPIN
TX123260503Medicare PIN