Provider Demographics
NPI:1396413977
Name:DEVEREUX, SAMUEL PAUL (CO, LPO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PAUL
Last Name:DEVEREUX
Suffix:
Gender:M
Credentials:CO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 HARRY HINES BLVD
Mailing Address - Street 2:2ND FLOOR SUITE 302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1838
Mailing Address - Country:US
Mailing Address - Phone:214-645-8250
Mailing Address - Fax:
Practice Address - Street 1:6011 HARRY HINES BLVD 2ND FLOOR SUITE 302
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-645-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2186224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist