Provider Demographics
NPI:1417057647
Name:RICHARD A. DEVORE, LLC
Entity Type:Organization
Organization Name:RICHARD A. DEVORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-791-6757
Mailing Address - Street 1:PO BOX 632603
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0027
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:8221 CORNELL RD
Practice Address - Street 2:STE 410
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2235
Practice Address - Country:US
Practice Address - Phone:513-791-6757
Practice Address - Fax:513-792-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2958161Medicaid
OH2958161Medicaid