Provider Demographics
NPI:1467561589
Name:DEVRIES, DAVID TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:217 WEAVER MINE TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7590
Mailing Address - Country:US
Mailing Address - Phone:919-967-7199
Mailing Address - Fax:919-401-1924
Practice Address - Street 1:2238 NELSON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8914
Practice Address - Country:US
Practice Address - Phone:919-401-1994
Practice Address - Fax:919-401-1924
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2007-00200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2064563OtherMEDICARE PTAN
NC2064563OtherMEDICARE PTAN