Provider Demographics
NPI:1184720245
Name:PEVEC, ROSEANNE E (MD)
Entity type:Individual
Prefix:DR
First Name:ROSEANNE
Middle Name:E
Last Name:PEVEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2725 CAPITOL AVE
Practice Address - Street 2:#404
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6004
Practice Address - Country:US
Practice Address - Phone:916-262-9456
Practice Address - Fax:916-262-9460
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74507207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G745070Medicaid
CA00G745072Medicare PIN
00G745070Medicare ID - Type Unspecified
CA00G745070Medicaid