Provider Demographics
NPI:1023196466
Name:DAVE, DEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVEN
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 RIVIERA STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-488-2234
Mailing Address - Fax:
Practice Address - Street 1:517 RIVIERA STREET
Practice Address - Street 2:SUITE C
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-488-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47546207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73291Medicare ID - Type Unspecified
FLC49486Medicare UPIN