Provider Demographics
NPI:1316008170
Name:MCDEVITT, JEFFREY BRYAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRYAN
Last Name:MCDEVITT
Suffix:
Gender:F
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:PO BOX 2508
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2508
Mailing Address - Country:US
Mailing Address - Phone:808-327-4357
Mailing Address - Fax:808-326-1549
Practice Address - Street 1:77-6447 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-327-4357
Practice Address - Fax:808-326-1549
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI02173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E35567OtherHMSA BC-BS OF HI
E35567OtherHMSA BC-BS OF HI
D36390Medicare UPIN