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NPI Code Detail

MEDICARE: DR. JEFFREY ELTING DEYO MD, PHD

MEDICARE: DR. JEFFREY ELTING DEYO MD, PHD
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
1208000000XPediatrics Physician15187RLA
22080P0207XPediatric Hematology & Oncology Physician15187RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619962032
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY ELTING DEYO MD, PHD
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 225-526-0002
Fax Number : 225-765-9196
Provider Business Practice Location Address
First Line : 8300 CONSTANTIN BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3489
Country : US
Telephone Number : 225-763-6337
Fax Number : 225-374-4661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 08/31/2021

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