Provider Demographics
NPI:1912086299
Name:DEVENYI, ZOLTAN J (MD)
Entity type:Individual
Prefix:
First Name:ZOLTAN
Middle Name:J
Last Name:DEVENYI
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 1:921 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4116
Mailing Address - Country:US
Mailing Address - Phone:843-497-6066
Mailing Address - Fax:843-497-8691
Practice Address - Street 1:921 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4116
Practice Address - Country:US
Practice Address - Phone:843-497-6066
Practice Address - Fax:843-497-8691
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13077207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8905132Medicaid
SC130771Medicaid
NC8905132Medicaid
SC130771Medicaid