Provider Demographics
NPI:1457857740
Name:DEVILLIER, JOSEPH EVAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EVAN
Last Name:DEVILLIER
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 1:270 E STATE ST STE 240
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4369
Mailing Address - Country:US
Mailing Address - Phone:330-596-6579
Mailing Address - Fax:
Practice Address - Street 1:270 E STATE ST STE 240
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4369
Practice Address - Country:US
Practice Address - Phone:330-596-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.142877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program