Provider Demographics
NPI:1558405597
Name:DEVORE, CARL MICHAEL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:MICHAEL
Last Name:DEVORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1813
Mailing Address - Country:US
Mailing Address - Phone:585-721-9811
Mailing Address - Fax:585-899-6017
Practice Address - Street 1:9 SPLIT ROCK RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1813
Practice Address - Country:US
Practice Address - Phone:585-721-9811
Practice Address - Fax:585-899-6017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine