Healthcare Provider Details

I. General information

NPI: 1619962032
Provider Name (Legal Business Name): JEFFREY ELTING DEYO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTANTIN BLVD
BATON ROUGE LA
70809-3489
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-6337
  • Fax: 225-374-4661
Mailing address:
  • Phone: 225-526-0002
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15187R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number15187R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: