MEDICARE: DAVIN DEUEL HS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1437816253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVIN DEUEL HS

Provider Business Mailing Address
First Line	:	6400 GAMBEL QUAIL RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5141
Country	:	US
Telephone Number	:	505-399-9049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 E 9TH ST STE 2693
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44199-9904
Country	:	US
Telephone Number	:	216-902-6260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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Directions to “ DAVIN DEUEL HS” Practice Location

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