Healthcare Provider Details

I. General information

NPI: 1568497964
Provider Name (Legal Business Name): STEWART ANDREWS DEEKENS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MALCOLM BLVD SUITE 150
RUTHERFORD COLLEGE NC
28671
US

IV. Provider business mailing address

730 MALCOLM BLVD SUITE 150
RUTHERFORD COLLEGE NC
28671
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-8684
  • Fax: 828-580-8439
Mailing address:
  • Phone: 828-580-8684
  • Fax: 828-580-8439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25258
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: