Provider Demographics
NPI:1295796126
Name:PAVELONIS, JOEL D (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:PAVELONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 S DOBSON ROAD
Mailing Address - Street 2:STE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-844-7100
Mailing Address - Fax:480-512-5486
Practice Address - Street 1:1500 S DOBSON ROAD
Practice Address - Street 2:STE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-844-7100
Practice Address - Fax:480-512-5486
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ30233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ733338Medicaid
AZZ101652Medicare PIN
AZ733338Medicaid