Individual
DR. BERNARD LOUIS FIORAVANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1510 W 90TH ST N, WAGONER, OK 74467-8159
(918) 519-1155
(918) 683-4416
Mailing address
1510 W 90TH ST N, WAGONER, OK 74467-8159
(918) 686-5552
(918) 683-4416
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
11797
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100005620A
—
OK
Enumeration date
11/03/2005
Last updated
02/21/2012
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