Provider Demographics
NPI:1346383148
Name:TEVES, VENANCIO S (MD)
Entity Type:Individual
Prefix:
First Name:VENANCIO
Middle Name:S
Last Name:TEVES
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 1:4810 N DAVIS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4810 N DAVIS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2341
Practice Address - Country:US
Practice Address - Phone:850-477-8109
Practice Address - Fax:850-478-2412
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92527207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277883100Medicaid
AL059192018OtherBLUE SHIELD
AL009942012Medicaid
FL93596OtherBLUE SHIELD
AL059192018OtherBLUE SHIELD
AL009942012Medicaid