Provider Demographics
NPI:1528044153
Name:DEVES, GERALD R (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:DEVES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PICKERING ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1967
Mailing Address - Country:US
Mailing Address - Phone:573-564-2101
Mailing Address - Fax:573-564-2130
Practice Address - Street 1:240 PICKERING ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1967
Practice Address - Country:US
Practice Address - Phone:573-564-2101
Practice Address - Fax:573-564-2130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32584208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41683Medicare UPIN