Provider Demographics
NPI:1285631440
Name:PAVOT, PIERRE V (DO)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:V
Last Name:PAVOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVENUE
Mailing Address - Street 2:#300
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-485-3535
Mailing Address - Fax:303-485-3536
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-485-3535
Practice Address - Fax:303-485-3536
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-03
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO412612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06840858Medicaid
CO68408528Medicaid
490298Medicare PIN
CO06840858Medicaid
H39024Medicare UPIN