Provider Demographics
NPI:1699846550
Name:DEVOE, JAMES F (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:DEVOE
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 1:2865 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2803
Mailing Address - Country:US
Mailing Address - Phone:573-776-1100
Mailing Address - Fax:
Practice Address - Street 1:4262 S AMHERST HWY STE 200
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-5363
Practice Address - Country:US
Practice Address - Phone:434-528-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15750207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC157500Medicaid
MO1699846550Medicaid
SCE239660281Medicare UPIN
MOMA1510008Medicare PIN
MO146640007Medicare PIN
MO137740008Medicare PIN
MO146660008Medicare PIN
SCE239660281Medicare PIN
SC157500Medicaid