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General NPI Number Information
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NPI Number | 1023026853
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Entity Type | Individual
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Provider Name | ANTHONY WAYNE DEVERAUX P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 664 SLATE AVENUE
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City | OWINGSVILLE
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State | KY
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Zip | 40360
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Country | US
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Telephone | 606-674-6690
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Fax | 606-674-6903
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | ASHLAND
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State | KY
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Zip | 41105-0790
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Country | US
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Telephone | 606-329-8588
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Fax | 606-329-8195
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0721
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License Number State | KY
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