MEDICARE: JAMES DEVOURSNEY 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	207ND0101X	MOHS-Micrographic Surgery Physician	ME80429	FL
2	207N00000X	Dermatology Physician	ME80429	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E5064Q	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1871696021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DEVOURSNEY MD

Provider Business Mailing Address
First Line	:	7740 BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3804
Country	:	US
Telephone Number	:	561-752-8000
Fax Number	:	561-752-8001

Provider Business Practice Location Address
First Line	:	7740 BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3804
Country	:	US
Telephone Number	:	561-752-8000
Fax Number	:	561-752-8001

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/05/2015

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Directions to “ JAMES DEVOURSNEY MD” Practice Location

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