MEDICARE: GORDON ROBERTS MCDEVITT JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	9400579	NC

General Provider Information

NPI Number	:	1073511234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON ROBERTS MCDEVITT JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 619
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28329-0619
Country	:	US
Telephone Number	:	910-592-8070
Fax Number	:	910-592-8549

Provider Business Practice Location Address
First Line	:	409C COOPER DR
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-2817
Country	:	US
Telephone Number	:	910-592-8070
Fax Number	:	910-592-8549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/15/2019

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