Provider Demographics
NPI:1194700914
Name:PLEVA, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PLEVA
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:PO BOX 11654
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1654
Mailing Address - Country:US
Mailing Address - Phone:928-445-4066
Mailing Address - Fax:928-445-4345
Practice Address - Street 1:5350 DISTINCTION WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8418
Practice Address - Country:US
Practice Address - Phone:928-445-4066
Practice Address - Fax:928-445-4345
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28809207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ567464Medicaid
Z107107Medicare PIN
AZ567464Medicaid