Provider Demographics
NPI:1558452151
Name:TAVERNETTI, RICHARD ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROLAND
Last Name:TAVERNETTI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3033
Mailing Address - Fax:415-923-3083
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3033
Practice Address - Fax:415-923-3083
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23135207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23404Medicare UPIN