MEDICARE: DR. GERALD R. DEVES D.O.

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	208D00000X	General Practice Physician	32584	MO

General Provider Information

NPI Number	:	1528044153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD R. DEVES D.O.

Provider Business Mailing Address
First Line	:	240 PICKERING ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1967
Country	:	US
Telephone Number	:	573-564-2101
Fax Number	:	573-564-2130

Provider Business Practice Location Address
First Line	:	240 PICKERING ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1967
Country	:	US
Telephone Number	:	573-564-2101
Fax Number	:	573-564-2130

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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