Provider Demographics
NPI:1285736058
Name:SHEBELUT, RICHARD CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CONRAD
Last Name:SHEBELUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:559-439-3936
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG471640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA238536OtherMEDICARE