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General NPI Number Information
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NPI Number | 1023000858
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Entity Type | Individual
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Provider Name | DAVID DEATON
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 2 MEDICAL PARK RD STE 300
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City | COLUMBIA
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State | SC
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Zip | 29203-6839
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Country | US
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Telephone | 803-545-5800
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Fax | 803-254-0821
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Provider Business Mailing Address
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Address Line | PO BOX 418283
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City | BOSTON
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State | MA
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Zip | 02241-8283
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Country | US
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Telephone | 703-558-1544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 51943
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 33799
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License Number State | DC
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