Healthcare Provider Details

I. General information

NPI: 1508898099
Provider Name (Legal Business Name): AJIT S DEOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 SWIFT BLVD
RICHLAND WA
99352-3514
US

IV. Provider business mailing address

780 SWIFT BLVD
RICHLAND WA
99352-3524
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-4611
  • Fax: 509-942-2185
Mailing address:
  • Phone: 509-942-3288
  • Fax: 509-946-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA73499
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2008003432
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2008003432
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA73499
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberM-16494
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA73499
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00039280
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: