=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730163817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY LYNN DEATON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2005
-----------------------------------------------------
Last Update Date | 09/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 MILLER ST SUITE 207 C
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-883-2500
-----------------------------------------------------
Fax | 336-883-9728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 MILLER ST SUITE 207 C
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-883-2500
-----------------------------------------------------
Fax | 336-883-9728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 38926
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------