Healthcare Provider Details

I. General information

NPI: 1114967239
Provider Name (Legal Business Name): MARIA A PAVEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BOGLE OFFICE PARK DRIVE SUITE B
SOMERSET KY
42503-2810
US

IV. Provider business mailing address

PO BOX 719
SOMERSET KY
42502-0719
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-3958
  • Fax: 606-676-0110
Mailing address:
  • Phone: 606-451-3958
  • Fax: 606-676-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number32321
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number32321
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number32321
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: