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Dr. Jeffrey Elting Deyo

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NPI Number Detailed Information

Provider Information:

Name: Dr. Jeffrey Elting Deyo
Gender: M
Provider License Number If Given: 15187R

NPI Information:

NPI: 1619962032
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 5/20/2015

Provider Business Mailing Address:

Address: 7777 HENNESSY BLVD STE.312
Baton Rouge, LA 70808
Phone Number: 2257636337
Fax Number: 2257614072

Provider Business Practice Location Address:

Address: 7777 HENNESSY BLVD STE.312
Baton Rouge, LA 70808
Phone Number: 2257636337
Fax Number: 2257614072

Provider Taxonomy:

Primary: 208000000X
Secondary (if any): 2080P0207X
State: LA

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