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NPI Code Detail

MEDICARE: JEFFREY LYNN DEATON MD

MEDICARE: JEFFREY LYNN DEATON MD
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
1207VE0102XReproductive Endocrinology Physician38926NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13300291OTHERUNITED HEALTHCARE
2189420OTHERMEDCOST
328024OTHERBCBS

General Provider Information

NPI Number : 1730163817
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY LYNN DEATON MD
Provider Business Mailing Address
First Line : 131 MILLER ST
Second Line : SUITE 207 C
City : WINSTON SALEM
State : NC
Zip : 27103-2508
Country : US
Telephone Number : 336-883-2500
Fax Number : 336-883-9728
Provider Business Practice Location Address
First Line : 131 MILLER ST
Second Line : SUITE 207 C
City : WINSTON SALEM
State : NC
Zip : 27103-2508
Country : US
Telephone Number : 336-883-2500
Fax Number : 336-883-9728
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 09/07/2016

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