MEDICARE: JOHN P DEVINE 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	208800000X	Urology Physician	04-20533	KS

General Provider Information

NPI Number	:	1376533075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P DEVINE MD

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE
Second Line	:	G100
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-537-8710
Fax Number	:	785-537-0562

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE
Second Line	:	G100
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2770
Country	:	US
Telephone Number	:	785-537-8710
Fax Number	:	785-537-0562

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/01/2011

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