Provider Demographics
NPI:1437816253
Name:DEUEL, DAVIN (HS)
Entity Type:Individual
Prefix:
First Name:DAVIN
Middle Name:
Last Name:DEUEL
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GAMBEL QUAIL RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5141
Mailing Address - Country:US
Mailing Address - Phone:505-399-9049
Mailing Address - Fax:
Practice Address - Street 1:1240 E 9TH ST STE 2693
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44199-9904
Practice Address - Country:US
Practice Address - Phone:216-902-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman