Provider Demographics
NPI:1083770622
Name:DEYAN, ALEXANDER B (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:B
Last Name:DEYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL
Mailing Address - Street 2:#508
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-720-9848
Mailing Address - Fax:949-720-9195
Practice Address - Street 1:360 SAN MIGUEL
Practice Address - Street 2:#508
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-720-9848
Practice Address - Fax:949-720-9195
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG675681207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G675681Medicaid
F11361Medicare UPIN
CA00G675681Medicaid