Provider Demographics
NPI:1215100615
Name:PEVETO, JOY SUSANNE (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:SUSANNE
Last Name:PEVETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6918
Mailing Address - Country:US
Mailing Address - Phone:972-613-6336
Mailing Address - Fax:972-613-8779
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-824-3200
Practice Address - Fax:214-824-0541
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP2338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology