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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 |
