Provider Demographics
NPI:1003033465
Name:PHILLIP W DEVOE MD PA
Entity Type:Organization
Organization Name:PHILLIP W DEVOE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-951-2709
Mailing Address - Street 1:1515 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2946
Mailing Address - Country:US
Mailing Address - Phone:321-951-2709
Mailing Address - Fax:321-952-2829
Practice Address - Street 1:1515 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2946
Practice Address - Country:US
Practice Address - Phone:321-951-2709
Practice Address - Fax:321-952-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027668207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0487Medicare ID - Type UnspecifiedGROUP NUMBER