Healthcare Provider Details

I. General information

NPI: 1164414678
Provider Name (Legal Business Name): DAVID PAUL DEYSHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 ISABEL DR
LEBANON PA
17042-7482
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-376-1180
  • Fax: 717-273-6937
Mailing address:
  • Phone: 717-376-1180
  • Fax: 717-273-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS005373L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: