Provider Demographics
NPI:1073800066
Name:DEDAVETS, ALEC (MD)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:DEDAVETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEH
Other - Middle Name:
Other - Last Name:DZEDAVETS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:#100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:916-450-1422
Mailing Address - Fax:
Practice Address - Street 1:400 PLUMAS BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5081
Practice Address - Country:US
Practice Address - Phone:530-749-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine