Healthcare Provider Details

I. General information

NPI: 1437306883
Provider Name (Legal Business Name): PATRICK PEVOTO, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 RENFERT WAY SUITE 100
AUSTIN TX
78758-5614
US

IV. Provider business mailing address

12200 RENFERT WAY SUITE 100
AUSTIN TX
78758-5614
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-8211
  • Fax: 512-452-4095
Mailing address:
  • Phone: 512-451-8211
  • Fax: 512-452-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG5480
License Number StateTX

VIII. Authorized Official

Name: PATRICK SCOTT PEVOTO
Title or Position: PRESIDENT
Credential: MD
Phone: 512-451-8211