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General NPI Number Information
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NPI Number | 1437306883
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Entity Type | Organization
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Legal Business Name | PATRICK PEVOTO, MD, PA
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 12200 RENFERT WAY SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78758-5614
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Country | US
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Telephone | 512-451-8211
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Fax | 512-452-4095
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Provider Business Mailing Address
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Address Line | 12200 RENFERT WAY SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78758-5614
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Country | US
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Telephone | 512-451-8211
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Fax | 512-452-4095
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK SCOTT PEVOTO
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Credential | MD
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Telephone | 512-451-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G5480
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License Number State | TX
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