Provider Demographics
NPI:1740381342
Name:RONALD LEE DEVORE MD INC
Entity Type:Organization
Organization Name:RONALD LEE DEVORE MD INC
Other - Org Name:DEVORE ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-312-9368
Mailing Address - Street 1:8439 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-312-9368
Mailing Address - Fax:937-312-9369
Practice Address - Street 1:8439 YANKEE ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-312-9368
Practice Address - Fax:937-312-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2380490Medicaid
OHDA3598Medicare PIN
OH9319013Medicare PIN
OH9319014Medicare PIN
OH9319011Medicare PIN