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General NPI Number Information
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NPI Number | 1174520068
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Entity Type | Individual
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Provider Name | JEFFERY L DEAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 1938 CHARLIE HALL BLVD UNIT B
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City | CHARLESTON
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State | SC
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Zip | 29414-6099
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Country | US
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Telephone | 843-442-0227
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 SPINNAKER LN
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City | CHARLESTON
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State | SC
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Zip | 29407-9659
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Country | US
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Telephone | 843-766-6082
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 12384
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License Number State | SC
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