Provider Demographics
NPI:1861507360
Name:PREVATTE, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:PREVATTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 NORTH CLYDE MORRIS BLVD., SUITE 200
Mailing Address - Street 2:HALIFAX FAMILY HEALTH CENTER
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2765
Mailing Address - Country:US
Mailing Address - Phone:386-947-4665
Mailing Address - Fax:386-258-4891
Practice Address - Street 1:201 NORTH CLYDE MORRIS BLVD., SUITE 200
Practice Address - Street 2:HALIFAX FAMILY HEALTH CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2765
Practice Address - Country:US
Practice Address - Phone:386-947-4665
Practice Address - Fax:386-258-4891
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME40803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068824000Medicaid
FL068824000Medicaid
FLD58907Medicare UPIN