Provider Demographics
NPI:1245556315
Name:VOLKOV, PAVEL (MD)
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:VOLKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6327 N FRESNO ST
Mailing Address - Street 2:STE# 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5236
Mailing Address - Country:US
Mailing Address - Phone:559-431-4020
Mailing Address - Fax:559-431-4589
Practice Address - Street 1:6327 N FRESNO ST
Practice Address - Street 2:STE# 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5236
Practice Address - Country:US
Practice Address - Phone:559-431-4020
Practice Address - Fax:559-431-4589
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA11927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEK680AMedicare PIN