Provider Demographics
NPI:1912979014
Name:PEVETO, RONALD LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LYNN
Last Name:PEVETO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10TH MEDICAL GROUP
Mailing Address - Street 2:4102 PINION DRIVE
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840
Mailing Address - Country:US
Mailing Address - Phone:719-333-5187
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DR
Practice Address - Street 2:ATTN: 90 MDG/SGP - CHIEF, AEROSPACE MEDICINE
Practice Address - City:F.E. WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3906
Practice Address - Country:US
Practice Address - Phone:307-773-5732
Practice Address - Fax:307-773-3809
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-10-27
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5479207Q00000X
CO381132083A0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine