Provider Demographics
NPI:1255912960
Name:RICHARD C SHEBELUT MD
Entity type:Organization
Organization Name:RICHARD C SHEBELUT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEBELUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-439-2229
Mailing Address - Street 1:6327 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5236
Mailing Address - Country:US
Mailing Address - Phone:559-439-2229
Mailing Address - Fax:559-435-7195
Practice Address - Street 1:6327 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5236
Practice Address - Country:US
Practice Address - Phone:559-439-2229
Practice Address - Fax:559-435-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty