Provider Demographics
NPI:1376550731
Name:PEVOTO, PATRICK SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:SCOTT
Last Name:PEVOTO
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 1:2373 G RD
Mailing Address - Street 2:STE 270
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1002
Mailing Address - Country:US
Mailing Address - Phone:970-242-2429
Mailing Address - Fax:
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:STE 270
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1002
Practice Address - Country:US
Practice Address - Phone:970-242-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD195837207V00000X
WAMD6099378207VX0000X
CO51000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46686258Medicaid
CO46686258Medicaid
TX00N26HMedicare ID - Type Unspecified
CO46686258Medicaid
COCOA107134Medicare PIN