Healthcare Provider Details

I. General information

NPI: 1629049135
Provider Name (Legal Business Name): ROBERT NEVETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

IV. Provider business mailing address

583 CARDINAL MEADOWS DR
WASHINGTON MO
63090-1264
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8090
  • Fax:
Mailing address:
  • Phone: 636-839-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR2H87
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: