Provider Demographics
NPI:1861478463
Name:LERTVARANURAK, VARAVOOT RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VARAVOOT
Middle Name:RAY
Last Name:LERTVARANURAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 PACIFIC AVE
Mailing Address - Street 2:172
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4301
Mailing Address - Country:US
Mailing Address - Phone:650-380-3318
Mailing Address - Fax:
Practice Address - Street 1:845 JACKSON ST
Practice Address - Street 2:RADIOLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4851
Practice Address - Country:US
Practice Address - Phone:415-677-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA717682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A717680Medicaid
CA00A717680Medicaid
H82609Medicare UPIN