Provider Demographics
NPI:1811992795
Name:DEVOE, PHILLIP W (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:W
Last Name:DEVOE
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 1:1515 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2946
Mailing Address - Country:US
Mailing Address - Phone:321-951-2709
Mailing Address - Fax:321-952-2829
Practice Address - Street 1:1515 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2946
Practice Address - Country:US
Practice Address - Phone:321-951-2709
Practice Address - Fax:321-952-2829
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027668207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46102OtherBLUE CROSS BS PROVIDER #
FL46102OtherBLUE CROSS BS PROVIDER #
FL46102ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
FLK0487Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER