Provider Demographics
NPI:1578599213
Name:DEATON, LOIS L (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:L
Last Name:DEATON
Suffix:
Gender:F
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:PO BOX 635526
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5526
Mailing Address - Country:US
Mailing Address - Phone:513-585-3635
Mailing Address - Fax:513-585-3189
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-585-3635
Practice Address - Fax:513-585-3189
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069207208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00370746OtherRR MEDICARE
OH0221272Medicaid
KY64951718Medicaid
OH0221272Medicaid
OH0794146Medicare PIN