Healthcare Provider Details

I. General information

NPI: 1376514968
Provider Name (Legal Business Name): PAUL DIX DEVERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHEFFIELD DR SUITE 101
COLUMBUS NJ
08022-9549
US

IV. Provider business mailing address

7000 ATRIUM WAY STE 6
MOUNT LAUREL NJ
08054-3917
US

V. Phone/Fax

Practice location:
  • Phone: 609-668-6797
  • Fax: 609-668-6798
Mailing address:
  • Phone: 609-668-6797
  • Fax: 609-668-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD070258L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07834000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: