Provider Demographics
NPI:1043522329
Name:DEEL, ROY R (DO)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:R
Last Name:DEEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228
Mailing Address - Country:US
Mailing Address - Phone:276-926-0200
Mailing Address - Fax:276-926-6675
Practice Address - Street 1:364 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-926-0200
Practice Address - Fax:276-926-6675
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043522329Medicaid
VAP01245138OtherRR MEDICARE
VA1871517151OtherVA MEDICAID GROUP
VA1043522329Medicaid
VAVVA242AMedicare PIN