R.C. Jereza M.D., Inc.

Key facts

NPI

1700920485

Entity type

Organization (NPI type 2)

Primary specialty

Hematology (Internal Medicine) Physician 207RH0000X

License

09488 (WV)

Legal business name

R.C. JEREZA M.D., INC.

Practice address

200 Raleigh Ave
Beckley, WV 25801-5944

Phone

(304) 252-8541

Fax

(304) 253-2507

NPI assigned

Feb 16, 2007

Organization subpart

No

Authorized official

Name

Ramon C. Jereza, MD

Title

President

Phone

(304) 252-8541

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700920485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RALEIGH AVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258015944",
            "telephone_number": "304-252-8541",
            "fax_number": "304-253-2507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RALEIGH AVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258015944",
            "telephone_number": "304-252-8541",
            "fax_number": "304-253-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R.C. JEREZA M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEREZA",
        "authorized_official_first_name": "RAMON",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-252-8541",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": "WV",
            "license": "09488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076323000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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