Provider Demographics
NPI:1548457245
Name:RICHARD S. DEMERA, M.D. INC.
Entity type:Organization
Organization Name:RICHARD S. DEMERA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DEMERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-903-4194
Mailing Address - Street 1:540 E HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2993
Mailing Address - Country:US
Mailing Address - Phone:559-431-0340
Mailing Address - Fax:559-431-0301
Practice Address - Street 1:540 E HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2993
Practice Address - Country:US
Practice Address - Phone:559-431-0340
Practice Address - Fax:559-431-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH01600Medicare UPIN
CAZZZ06400ZMedicare PIN