MEDICARE: SCOTT A. DEVILLENEUVE, MD PA

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	208600000X	Surgery Physician	L9173	TX

General Provider Information

NPI Number	:	1528240884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT A. DEVILLENEUVE, MD PA

Provider Business Mailing Address
First Line	:	8865 SYNERGY DRIVE
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6521
Country	:	US
Telephone Number	:	972-562-1119
Fax Number	:	972-529-9510

Provider Business Practice Location Address
First Line	:	8865 SYNERGY DRIVE
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6521
Country	:	US
Telephone Number	:	972-562-1119
Fax Number	:	972-529-9510

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHERRY RAGLAND
Credential	:	CMOM, CMC
Telephone Number	:	972-562-1119

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	06/08/2012

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