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NPI Code Detail

MEDICARE: GEORGE A DEVAULT JR. MD

MEDICARE: GEORGE A DEVAULT 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
1207RN0300XNephrology Physician37136CO
2207R00000XInternal Medicine Physician37136CO

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 : 1861477853
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE A DEVAULT JR. MD
Provider Business Mailing Address
First Line : 1914 LELARAY ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-2800
Country : US
Telephone Number : 719-632-7641
Fax Number : 719-632-2925
Provider Business Practice Location Address
First Line : 1914 LELARAY ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-2800
Country : US
Telephone Number : 719-632-7641
Fax Number : 719-632-2925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 02/11/2016

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Directions to “ GEORGE A DEVAULT JR. MD” Practice Location

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