Provider Demographics
NPI:1780637249
Name:PEVARSKI, DENNIS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOSEPH
Last Name:PEVARSKI
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 1:6449 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1655
Mailing Address - Country:US
Mailing Address - Phone:727-381-0275
Mailing Address - Fax:727-345-8025
Practice Address - Street 1:6449 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1655
Practice Address - Country:US
Practice Address - Phone:727-381-0275
Practice Address - Fax:727-345-8025
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME704452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252444900Medicaid
990008915OtherRAILROAD MEDICARE
FL41277OtherBLUE CROSS BLUE SHIELD
FL41277OtherBLUE CROSS BLUE SHIELD
FLG64393Medicare UPIN
FL41277Medicare ID - Type Unspecified