Provider Demographics
NPI:1629285812
Name:MCDEVITT, WALTER JOSEPH JR
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:MCDEVITT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W. REGENT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-324-5264
Mailing Address - Fax:
Practice Address - Street 1:8TH REGIMENTAL AID STATION
Practice Address - Street 2:2ND MARINE DIVISION
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0101
Practice Address - Country:US
Practice Address - Phone:910-451-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman